



Copyright)!?. 



COPYRIGHT DEPOSIT. 



PUBLIC SANITATION 

AND 

OTHER PAPERS 



By 

CLEMENT A. WHITING, Sc. D., D. O. 

Chairman of the Faculty, The Pacific College of Osteopathy; 

Health Officer of South Pasadena; Director, Southern 

California Academy of Science, Chairman 

of its Biological Section. 



19 16 

A. T. STILL RESEARCH INSTITUTE 

Publication Bureau 






Copyright, 1916, by the 
A. T. Still Research Institute 



1 



3r^ 



MAY 25 1916 



^CU431222 



PRINTED BY 

BAUMGARDT PUBLISHING CO. 

LOS ANGELES 



TABLE OF CONTENTS 

Page 

Preface 7 

Public Sanitation and Personal Hygiene; Introduction 11 

Disease Germs Outside of the Body 14 

Night Air 16 

Disease Germs Outside of the Body; Continued 17 

Disease by Personal Contact 20 

The Spread of Disease by Carriers 24 

Cleanliness and Isolation 28 

Infection from Fomites 32 

Infections Through the Air 35 

The Cost of Crime 37 

Failure of Isolation in Contagious Diseases 38 

The House Fly 40 

Dipterous Insects: Flies 41 

Flies and Filth 44 

Mosquitoes 45 

The Guardian Angel 48 

Malaria 49 

Bedbugs and Cockroaches 51 

Sports 53 

The Spotted Fever Tick of the Rocky Mountains 54 

The Protozoan 57 

Protozoan Diseases 60 

Amoebic Dysentery 64 

A Strange Intestinal Mass 66 

A Few Human Parasites 67 

Tapeworms 72 

Nematode Worms 76 

Hook Worm Disease 79 

Trematoda or Flukes 80 

Poison Oak 83 

Infantile Paralysis 86 

Measles and Aftermath 87 

Pellagra 89 

Hydrophobia 91, 93, 95 

Typhoid Fever 96 

Tuberculosis 97 

One-Foot Skating 99 

Bubonic Plague 100, 102 

Rats and Public Hygiene 104 



CONTENTS 



Sewage in California 106 

Health Authority Against Cesspools 108 

Criminals and Sickness 109 

Infection by Means of Water and Meat 110 

Food Preservatives 113 

Preservation of Food Supplies 115 

Proof of Contamination of Food 118 

Water as a Carrier of Disease 120 

Good Water 123 

Cold Water 124 

Milk 125, 127 

Certified Milk 129 

Preservation of Milk 130 

Diseases Which May Be Acquired from Milk 131 

Ice Cream 133 

The Oyster 134 

Health Notes 136 

High Heeled Shoes 137 

How Sick People Get Well 138 

The State and the Individual 140 

Useful vs. Useless Industry 141 

Young People and Tobacco 143 

Late Hours 145 

Ventilation 147 

Play Grounds for Children 149 

School Architecture 150 

Shall the Tonsils be Removed? 152 

The Gonococcus 154 

How Long Shall We Live? 155 

Old Age 156 

When the Patient Dies 159 

The Relationship of the Osteopathic Physician to Public Health 161 

What of the Future ? 168 

The Development of the Epithelial Organs 171 

A Case of Spleno-Medullary Leukemia 181 

A Hydatid Mole 185 

Some Common Abnormalities of the Uterus 188 

Some Experiments with the Opsonic Index 190 

Observations on a Fetal Calf 193 

Investigations of the Phagocytic Index 194 

Experiments with Drugs 197 

The Purin Bodies 198 

Hemorrhage into the Fetal Spinal Cord 203 

A Dermoid Cyst 204 



CONTENTS 5 

Page 

A Few Words on Tumors 205 

Which Weighs Most, Egg or Chicken? 206 

Degenerates 208 

Albumin and Casts , 212 

Spermatozoa 213 

Our Native Birds (Utah) 216 

Address to P. S. O. Graduating Class 221 

The Place of Physicians in Modern Society 222 

The Course of Study in Osteopathic Schools 224 

The Value of the Study of Bacteriology 227 

The Education of the Osteopath 229 

The Value of Laboratory Diagnosis 231 

The Importance of Laboratory Diagnosis to the Physician 233 

Some Facts Relating to Laboratory Diagnosis 237 

Laboratory Examinations 239 

The Side of the Colleges 241 

The Relationship Between the American Osteopathic Association 

and the Associated Colleges of Osteopathy 243 

Educational Standards 246 

The State University and the Medical Colleges 247 

The Independent College vs. The University College 249 

Degrees 250 

State Bureau of Health 254 

Hysterical Fear of Paralysis 256 

Fee-Splitting 258 

Earlier Research Work 259 

The Thermometer 262 

The United States Pharmacopoeia 264 

Medicines and Their Effects 266 

Ichthyol 268 

Medicines that are "Harmless" 269 

Addiction to Drug Habits 270 

Absinthe 272 

Copper Sulphate in Epistaxis 273 

Mendel's Law 274 

Artificial Fertilization of Eggs 275 

The Ancient City of Santa Fe 276 

American School of Archeology 279 

Osteopathic Physicians 281 

Woman's Suffrage 283 

The Cost of Living 284 

The Oak Tree 285 

Hippocrates 287 

Galen 289 



6 CONTENTS 

Page 

Aristotle 291 

Averroes 293 

Marcellus Malpighi 295 

Antony Van Leeuwenhoek 297 

George Combe 299 

Joseph Lister (Lord Lister) 301 

Elie Metchnikoff 303 

Alfred Russel Wallace 306 

Dr. Alexis Carrel 307 

Sir William Crookes 309 

William J. Hayden 310 

APPENDIX I 

The Opsonic Index as Affected by Mechanical Stimulation 312 

APPENDIX II 

Biological Relations, — Starch 314 

Biological Relations, — Nitrogen 316 

Adaptations 318 

Infections 321 

Modern Diagnosis 322 

Neoplasms 325 

APPENDIX III 

Death in Pulmonary Tuberculosis 330 



* PREFACE 

No argument is required to show that health is at the foundation 
of all happiness and success. It seems that health rests upon a three- 
fold support : 

One of these supports is inheritance; it is the right of every child 
to be well born, this means that the parents must both be free from any 
transmissible disease. 

The new science, Eugenics, is being rapidly developed, and the 
time is not far distant when the state will no longer give its sanction 
of marriage to those who are unfitted to become the parents of worthy 
citizens. 

Assuming the child to be born into the world inheriting a good con- 
stitution, the second demand for good health is good personal hygiene. 
By this is meant, such care as the individual must give himself, or such 
as he must receive from those upon whom he is dependent. 

It is obvious that the preparation of food, the arrangement and 
amount of clothing, the ventilation of private rooms, and the ordinary 
care of the body, must devolve upon the individual; and it is equally 
obvious that the wisdom with which the individual discharges these ob- 
ligations to himself, will very largely determine his health. 

The third leg of the tripod is Public Hygiene. No matter how good 
the constitution may be which one inherits, and no matter how well one 
may look out for his various personal needs ; his health is still dependent 
upon the purity of his water supply, the cleanliness and purity of his 
milk, the ventilation of public halls which he may enter, and the proper 
quarantine of contagious diseases, with which he might otherwise come 
in contact. 

All of these last named subjects belong to the domain of public 
hygiene. During the last twenty-five years there has been a vast amount 
of legislation on the subject of public hygiene, and no officers in the 
United States are entrusted with more arbitrary power than the health 
officers ; and there are no public regulations to which people at large 
yield more cheerful obedience than they do to the regulations that are 
made in the real or supposed interests of public health. 

This being the case, it means that a great burden of responsibility 
is thrown upon those who administer the laws for the promotion of 
public hygiene. It is greatly to the credit of the American people that 

*So. Pas. Rec, Sept., 1912. 



8 PREFACE 

the great power placed in the hands of health boards and health officers 
has seldom been abused, and when abuses have occurred they have been 
due, generally, to a mistaken zeal, rather than to any attempt on the 
part of the health officer to be tyrannical. 

There is danger, however, that the best intentioned health author- 
ities may make serious mistakes, and one of the most serious mistakes 
which they are in danger of making, is in placing too much stress upon 
bad conditions and in that way arousing unnecessary and injurious 
fears on the part of the public. 

Teachers long ago learned that it was a mistake to place before 
students unworthy and improper examples of any kind. It was found 
that when the wrong is placed before the student, it unduly impresses 
itself upon his mind, and even if the right was placed close by, he was 
likely, in future times, to confuse one with the other. 

So in teaching public hygiene to the public at large, it is un- 
doubtedly better to place before them good conditions which they are 
to imitate, rather than place before them evil conditions which they 
should avoid. 

Then there is another factor which is of great, though unmeasured 
importance, and that is the depressing influence of fear. All thought- 
ful physicians recognize the fact that immunity from infection is a 
variable factor and that anything which lowers vitality and impairs the 
digestion tends to increase the susceptibility to communicable diseases. 

Somebody makes Job say, "The evil which I feared hath come upon 
me" and the expression of Job is largely repeated in life today. Paul 
was wise when he advised people to think upon the things which were 
good, pure, etc., as this always tends to strength. 

The extent to which even the educated mind is biased by precon- 
ceived ideas is shown by the readiness with which trained physicians 
are wont to recognize cases of a disease which takes a strong hold upon 
the public mind, even when such a disease does not exist. 

One may smile at the readiness with which slight stomach disorders 
are diagnosed as infantile paralysis, when that disease is expected, and 
how readily cases which are caused by poison oak become small-pox, 
when the mind is firmly fixed upon small-pox. 

In cases of this kind, it would be grossly unjust to assume a will- 
ful deception ; they simply illustrate to what a degree we are dominated 
by preconceived ideas. Cases like these are, of course, unfortunate, 
as they tend to bring necessary public health measures into disrepute. 



PUBLISHER'S NOTE 



It is with great pleasure that the useful and accurate papers left 
by Dr. Clement A. Whiting are thus offered in permanent form to 
that profession and that public which he so long, so faithfully, so 
thoughtfully, and so efficiently served. 

The small paragraphs are taken from lectures, and from certain 
longer articles of merely local or temporary interest. 

The publication of these papers in book form has been made possi- 
ble only by the courtesy and assistance of Dr. Lillian Whiting, Mrs. 
Nellie Keith, of the South Pasadena Library, the Journal of the Ameri- 
can Osteopathic Association, the Western Osteopath, the South Pasa- 
dena Record and its predecessor, the South Pasadenan, the Osteopath 
(published by the Pacific School of Osteopathy), the Bulletin of the 
Southern California Academy of Sciences, and the Osteopathic World. 
For permission to use these papers, and for help in collecting them, cor- 
dial gratitude is due. 

Publication Bureau, A. T. Still Research Institute. 



"It has been said of old 'Ye shall know the truth, and the truth 
shall make you free,' and we have been thinking of this as referring 
to big philosophical and theological and poetical things. We are 
losing sight of a great truth, a powerful agency for good, in thus dis- 
torting the words from their original significance. It is the plain, 
simple, matter-of-fact things that make us free from our most grievous 
ills; it is the simple and unpretty facts of the transmission of disease 
that give us the ability to keep free from illness; it is the knowledge 
of the physiological facts of life that enable us to make the most out of 
life; it is in the solution of the problems associated with crime and 
ignorance and in the understanding of things that are often repugnant 
to every sense of what is beautiful and fine, that we attain freedom from 
every physical and mental and moral disability. Things are not true 
just because they are pretty, or just because they fit our preconceived 
ideas of what truth ought to be; a thing is true because it is a fact, 
and it is the facts of life, cleanly and clearly appreciated, that make us, 
in the broadest and finest sense, free." 

(Address to Freshman class). 



PART I. 
Public Sanitation and Personal Hygiene 

^INTRODUCTION. 

The modern physician occupies a two-fold position. On the one 
hand he is specifically employed by his patients to render them a spe- 
cial service; on the other hand he is a licensed officer of the state 
charged with the important duty of aiding in the prevention of and 
the spreading of contagious diseases. In the discharge of his first 
duty he must do everything in his power to promote the well being 
of his patients. In the discharge of his second duty he must remember 
that however great is his obligation to his patients, his duty to the 
public is still greater. In the discharge of his public duty he must be 
the lieutenant of the local health officer, and the more faithfully he 
co-operates with this official the greater is the public value of the 
physician. 

No right-minded person will ever undertake to minimize the im- 
portance of helping those who are sick to recover their health, but it 
is still more important to keep others from being sick by preventing 
the spread of disease. The number of people whom any one phy- 
sician can aid in recovering from disease is very small compared with 
the number of people whom the physician may aid in protecting from 
disease. About the first thing which a physician should do when he 
establishes himself in a new location is to become acquainted with 
the members of the Board of Health and through the executive officer 
of the Board to co-operate with them in everything that makes for the 
general well-being of the city. The physician should immediately in- 
form himself in regard to the health regulations not only of the state, 
but also of the community in which he expects to practice. 

Public sanitation in its broadest sense means very little more than 
applied bacteriology. This being true, it follows that the physician 
must be a bacteriologist. It is not very unusual to meet with physicians 
of all the schools of practice who say that while they studied bac- 
teriology when they were in the medical college they have become rusty 
since their graduation. Those who permit themselves to do this are, 
of course, wholly unfit to discharge their duties to the state in an in- 
telligent manner. They are, from a professional standpoint, in some- 
what the same position that a business man would be from a business 

*Jour. A. O. A., Feb., 1912. 



12 PUBLIC SANITATION AND OTHER PAPERS 

standpoint who had learned to read when he was a schoolboy but who 
had since forgotten that art. 

During the period of our Civil War the world was appalled at the 
hideous loss of life. During the four years of war the Federal army 
lost by those directly killed in battle, 110,070 men. It is probable that 
the loss on the Southern side was equal to this and possibly greater, 
but if this were true, even if this enormous number had to be doubled, 
it would still be less than the number of children under two years of 
age who are reported to have died in the four years between 1903 and 
1907, for during that period there were reported the deaths of 271,773 
children under two years. 

It is impossible to express in words or figures the social and finan- 
cial loss which comes from such an appalling death rate, and when we 
know that a large number of these cases are preventable, were proper 
attention paid to public sanitation, it must be felt that the time is ripe 
for a vigorous movement toward bettering living conditions. We now 
know that tuberculosis is a communicable disease. We know that it is 
a preventable disease. We know that it is a disease from which the 
patient may readily recover, and yet knowing these things we still 
suffer a loss of more than 150,000 persons every year from this cause 
alone. That is, more than four hundred persons die each day from a 
disease from which they could be protected and from a disease from 
which they might recover could they be placed under favorable con- 
ditions at the proper stage of the disease. 

Aside from the social side of the loss, which can neither be repre- 
sented in words nor figures, the money loss is more than $1,000,000,000 
per year. Surely if some Congress should propose to lay a tax of a 
billion dollars a year upon the people of the United States a protest 
would arise which would burst open the gates of high heaven, and yet 
we quietly submit to the infinitely more onerous one imposed by con- 
ditions which we can prevent. 

One of the important lessons which must be impressed upon us as 
a people is the fact that early death is absolutely indefensible. From 
a broad survey of biology it appears that death is absolutely inevitable, 
but when it comes it should come as physiological death and not as 
death due to some abnormal condition. It is time that the custom of 
trying to reconcile people to the death of children should cease, and 
instead of seeking to impress upon a mourning community that they 
must reverently bow their heads in humble submission to their loss, 
we should in fitting language arouse them to a recognition of their duty 
in preventing further losses of the same kind. Even in the hour of 



INTRODUCTION 13 

trial and affliction, truth is better than fiction. The parent grieving 
over the untimely death of a child, the brother mourning the untimely 
death of his sister, can find no truer consolation than the thought that 
they may by their efforts aid in preventing others from suffering as 
they are obliged to suffer. 

Insects in the United States cause a monetary loss of more than 
one billion dollars per year, and it is probable that much fatal sickness 
may be traced directly or indirectly to this source. This loss of life 
and loss of property can be abated only by an accurate knowledge of 
the life history of these pests. It is asserted on good authority that 
during the Spanish War many more soldiers died from the effect of 
flies than from the effect of Spanish bullets. Some recent experiments 
which have been made show that the average fly carries about 1,250,000 
bacteria upon the various parts of his body, and when we think of the 
filth which flies unhesitatingly visit, we need not be surprised to know 
that many of these bacteria are pathogenic. The few flies which can 
be killed in traps, by fly paper and other means amount to practically 
nothing, and measures of this kind will never appreciably reduce their 
number. It is only by a knowledge of the life history of the fly, by 
absolutely killing them before they are hatched, that we can reduce 
the danger from them. 

All of this belongs to public hygiene. It is along these lines that 
the physician must aid in the education of the public. It is not wise 
to arouse profitless fears, but the physician must know enough of ap- 
plied biology, and he must be enough of a public hygienist to give 
accurate information in regard to these important matters. In almost 
every city steps are being taken to educate the people at large along 
the lines of public health, and the members of the osteopathic profes- 
sion should be ready to take a leading part in this great work. 

It is for the purpose of awakening an interest along these lines 
that the Journal has introduced a department of Public Sanitation. 



If there is any lesson which we need to learn more than another, 
it is that we live in a world of cause and effect ; that from a standpoint 
of health, at any rate, there is no such thing as vicarious atonement; 
that disease comes as a result of a violation of the laws of our beings, 
and that disease can only be prevented by a thorough understanding of 
the causes of disease and an intelligent avoidance of those things which 
produce it. 



14 PUBLIC SANITATION AND OTHER PAPERS 



^DISEASE GERMS OUTSIDE OF THE BODY. 

From very early times it has been believed that many diseases are 
due to malarial vapors, or emanations, which were either gaseous or 
non-gaseous. These vague terms were applied to conditions which 
were supposed to originate in all kinds of animal and vegetable filth, 
in swamps and in other noisome places. This line of thought, of course, 
meant that diseases were traced to conditions outside of the human 
body and by 1850 a considerable philosophy of disease based upon this 
theory had been worked out. At this time it was strongly suspected 
that diseases were due to organisms of some kind which originated 
outside of the human body and as bacteria were found to be numerous 
in such places as before named, pathologists were tracing disease to 
them, and from the belief that disease germs originated and multiplied 
in filthy places arose the supposed necessity of cleanliness in the inter- 
ests of public health. 

It was twenty-five or thirty years after this time that laboratory 
methods clearly and positively showed that very few pathogenic organ- 
isms increased in number outside of the animal body, and that patho- 
genic organisms are almost entirely, if not entirely, parasitic in their 
nature and that consequently they cannot increase outside of the body 
of their host. I am going to cite a few diseases to show the difference 
between these theories which are really conflicting, but which do not 
appear on the surface to be radically different. 

It has long been known that tetanus, or lock jaw, results from 
punctured wounds, and that the danger of tetanus is greatly increased 
if dirt of any kind is carried into the wound. This not unnaturally led 
bacteriologists to believe that the bacillus producing tetanus normally 
lived in the soil and that its introduction into the animal body is simply 
an unnecessary incident in its life. This belief was strengthened by the 
observed fact that the bacilli increased in number in cultivated soil. 
While it is barely possible that the bacillus may reproduce itself outside 
of the animal body, its increase in numbers in the soil is not positive 
evidence of this fact. We now know that the bacillus of tetanus is a 
normal inhabitant of the alimentary canal of the horse. It is reasonably 
certain that it increases in number in this location by reproduction, and 
as the excrement of the horse is largely used for fertilizing land, it is 
easy to see how the bacilli may continue increasing in numbers in the 
soil without reproducing themselves there. We know that this bacillus 

*Jour. A. O. A., May, 1912. 



DISEASE GERMS OUTSIDE OF THE BODY 15 

has extraordinary powers of resistance and that it is not easily killed. 
Moreover, it is one of the spore-producing bacteria and the spores have 
even greater powers of resistance than have the bacilli. Careful ex- 
periments have shown that the spores may retain their vitality outside 
of any culture medium for at least sixteen years. This being true, it 
follows that the number of bacteria in any given soil may represent the 
accumulation of sixteen years or more of time. It seems quite certain 
that all of the stories which have been told of the infection of the soil 
may be explained by the hypothesis already given. 

Anthrax is another disease which has been traced to the soil and 
there seems to be some reason for believing that under some conditions 
the bacillus producing this disease may increase by reproduction in the 
soil. It is also true that this is a spore-producing bacillus and that both 
the bacillus and its spores possess remarkable powers of resistance and 
longevity. In some cases which have been carefully analyzed it has 
been found that the waste from tanneries, and other places where the 
hides of animals are used, has been discharged upon the ground and 
thus the bacilli have been added to the soil by these constant additions, 
rather than by reproducing themselves. There is at least one recorded 
case where careful bacteriologists were of the opinion that anthrax 
bacillus reproduced itself in a pond of water. Admitting that reproduc- 
tion may occasionally occur outside of the body and that the bacilli pro- 
duced in either the soil or in water may cause an infection resulting in 
anthrax, the fact still remains that the danger of contracting the disease 
directly from the infected animal is very much greater than is the danger 
of contracting it from infested soil or water. 

No disease is more regularly traced to external conditions than is 
typhoid fever, and yet careful bacteriologists seriously question the ex- 
tensive increase in numbers of these bacilli outside of the human body. 
It is known that they may retain their vitality in soil for a considerable 
length of time, but it is highly improbable that they reproduce in the 
soil. It is quite well known that sewage which may at first contain 
large numbers of these organisms soon become free from them. Water 
may act as a carrier of the typhoid bacilli and they may retain their 
vitality in it for a considerable length of time, but it is not known that 
they increase in this medium. The bacillus is not killed even when 
water is frozen and so they may be carried in ice, but no one has ever 
suspected their increasing in numbers in the ice. Oysters may become 
infested with the bacilli, but there is little reason for supposing that 
they materially increase in number while in contact with this mollusk. 



16 PUBLIC SANITATION AND OTHER PAPERS 

Milk is known to be an excellent culture for the typhoid bacilli and it is 
very certain that it not infrequently acts as a carrier of them, but it is 
only when the milk is sterilized and a pure culture of the bacilli is added 
to the milk that they undergo any great increase by reproduction in this 
medium. Even if they are present in unsterilized milk, they are soon 
prevented from increasing their numbers by the products produced in 
the milk by other bacilli. 

These cases already cited, and some which I shall venture to 
present in a future issue, indicate that the danger of contracting disease 
by immediate contact with one already afflicted with it is very much 
greater than is the danger of contracting disease by means of fomites. 



*NIGHT AIR. 



There is a strange and absolutely foundationless prejudice on the 
part of many people against what is commonly called "night air." 
Take the year through, the sun is below the horizon one-half of the 
time and, as this constitutes night, it really means that we have to 
breathe "night air" one-half of each year, if we breathe at all. Many 
otherwise intelligent people seem to think that if the windows are duly 
closed that "night air" is shut out. As a matter of fact, the air in the 
dwellings is as much "night air" as is the air outside of the houses. 
All that closing the windows does is to obstruct ventilation and thereby 
permit the air to become utterly unfit for respiratory purposes. 

The plain truth is that the prejudice against "night air" has been 
based upon the fact that people have refused to allow their rooms to be 
properly ventilated. It is never a good thing either during the night or 
during the day to allow a draft of air to fall upon any one part of the 
body and either unduly heat or unduly chill that part. Anything of 
this kind always tends to destroy a well-balanced circulation and this is 
always unfortunate. It is much less injurious to allow the whole body 
to be chilled than to permit a small area of it to be chilled. 

No one need fear breathing so-called "night air" in the slightest 
degree. Bed-rooms should have doors and windows opened wide, and 
if one can sleep on a porch where there is absolutely no obstruction 
to the circulation of the air, he is, indeed, fortunate. If one is so 
unfortunate as to live in a mosquito infected area, these insects should 
of course be excluded, but health and good sanitation demand an abso- 
lutely unlimited supply of pure air. 

*West. 0st„ Nov., 1913. 



DISEASE GERMS OUTSIDE OF THE BODY 17 



-DISEASE GERMS OUTSIDE OF THE BODY. 

CONTINUED. 

Few subjects are of more importance to the public hygienist than 
is the question as to how long pathogenic bacteria will live outside of 
the human body. As one reads the literature of this subject he can 
only feel that surprisingly little is really known, as the views which 
are expressed by competent writers are so sadly at variance with each 
other. The best authorities which I have been able to consult are of 
the opinion that the bacilli which produce cholera may, under favor- 
able conditions, live about two months in moist earth, but is probable 
that they do not live so long as this under perfectly natural conditions 
— indeed, two weeks has in several cases proved to be the limit of time 
in which it was possible to recover the bacillus from earth which had 
received no artificial care. In several cases the bacilli have been re- 
covered from the bodies of patients dying from the disease a month 
after death, and this has been true even when the body has been in- 
jected with preservatives. Experiment has shown that they are very 
short lived in milk, and while they may live for several days in sweet 
milk, they perish almost immediately in sour milk, and there seems to 
be very little evidence that they appreciably increase in numbers either 
in the moist ground or in milk. 

In the outbreaks of yellow fever, which occurred in the South some 
years ago, it was believed that the disease was spread by personal 
contact and through various kinds of intermediate matter, and at one 
time whole cities in the South were placed under a quarantine. Further 
investigation has shown that all the efforts which were once employed 
to guard against malaria and yellow fever were wholly without effect, 
as these diseases are now known to be spread almost entirely, if not 
entirely, by special species of mosquitoes ; in other words, it was not 
the bad air from the swamps which produced the malaria, but the 
mosquitoes which bred in stagnant water. This one discovery has 
done more to make possible the Panama Canal than perhaps any other 
one thing. It is pathetic to read of the precautions which were form- 
erly taken on the Isthmus to protect people from tropical diseases, and 
to see that almost everything was done that could be done except the 
one supremely necessary thing; that being to protect people from the 
bites of mosquitoes and other tropical insects. The history of these 

*Jour. A. 0. A., Oct., 1912. 



18 PUBLIC SANITATION AND OTHER PAPERS 

diseases teaches us in the most striking manner the impotence of 
good intention not directed by absolute knowledge. 

Tuberculosis, pneumonia, influenza, gonorrhea and syphilis form 
a striking group of serious diseases where there is reason to believe 
that the organisms producing them are never naturally increased out- 
side of the human body. It is true that at the present time all of the 
organisms producing these diseases may be successfully cultivated 
out side of the human body, but as before stated, there is no reason 
to believe that they ever increase in nature. The germs producing 
gonorrhea and syphilis are certainly unable to live for more than a 
brief period outside of the animal body. The germs producing the 
other diseases may live somewhat longer, but even they are quickly 
destroyed if exposed to the light of the sun. 

In 1902 and 1903 there was a serious outbreak of cholera in the 
Philippine Islands. Owing to the almost total lack of sanitation at that 
time, body wastes of all kinds were promiscuously thrown on the 
ground, and in whole villages the soil must have been thoroughly per- 
meated with the germs of cholera; nevertheless, the epidemic there 
was not long lived. Careful examination showed that the rice and 
other foods sold in the streets contained bacilli of cholera, and there is 
much good reason for believing that the disease was spread more by 
the food than by the germs in the ground. No evidence was accumu- 
lated that the germs showed any tendency to increase in numbers in 
the foods just mentioned. 

It is not very unusual for typhoid fever and cholera to be asso- 
ciated with each other ; when this is the case, there is a marked ten- 
dency for the two diseases to increase and decrease together. This 
leads one to believe that they are both spread in about the same man- 
ner, and in both cases there seems to be very much greater danger of 
infection passing directly from one person to another by contact, than 
there is of the bacilli being carried by some intermediate object, though 
the danger of the intermediate object must not be overlooked. It is 
hard to find any two diseases which have more profoundly affected 
the history of mankind than yellow fever and malaria. Under various 
names these diseases have been known from earliest times, and among 
peoples of almost all nations. Some of the most fertile regions of the 
earth have been regarded as uninhabitable because of the presence of 
one or the other, or both of these diseases. Some modern historians 
suspect that great Persian armies, which at one time invaded Europe, 
were driven back quite as much by malaria as by the valor of the 



DISEASE GERMS OUTSIDE OF THE BODY 19 

Greeks. The very word malaria indicates what was supposed to be 
its origin, the word meaning "bad air," and so long as this view pre- 
vailed it was, of course, impossible to accomplish anything in com- 
bating this disease. 

The amebic dysentery is now becoming a disease with which we 
have to reckon. This is especially true on the Pacific Coast, where 
soldiers and other travelers are constantly returning from the Philip- 
pine Islands, where the disease is especially common. As in the case 
of so many other diseases, there is little reason to believe that the amebae 
producing this disease multiply to any extent outside of the human 
body. This ameba will probably live for some time in water, and it 
may possibly increase in numbers in milk, but the increase for the most 
part occurs only in the body of the person infected. 

There are many bacteria which are especially known as the 
bacteria of suppuration; the most important of these are the Micro- 
coccus aureus, Micrococcus albus, Micrococcus citreus and Strepto- 
coccus pyogenes; these are frequently found in the tonsils and 
lymphatic glands and in the deeper layers of the skin without produc- 
ing any appreciable effect. It is possible that to a limited extent these 
may increase in numbers outside of the body, but the extent to which 
they increase is undoubtedly very limited. 

If the statements contained in this article are true, it means that 
some of our views in regard to public hygiene have got to be revised. 
Aside from anthrax and tetanus, and possibly some of the pus-pro- 
ducing organisms, few of the pathogenic bacteria increase in filth, and 
if this is so, filth as the term is ordinarily used, is somewhat less dan- 
gerous than we have been taught to suppose it to be. This certainly 
should not make us more tolerant of it, because in many ways it must 
act to lower vitality, and it is certainly offensive to the finer sensi- 
bilities; but when we are dealing with diseases it is important to 
know the truth, and if it is true that the pig-pen and chicken-yard are 
not as much of a menace to health as we once supposed, our love for 
the beautiful and the clean will not permit us to more readily tolerate 
them where they should not be. 



The principal reason why a man who is down, remains there, and 
continues to appear as ordinary as his environment, is because he per- 
mits his mind to be impressed with everything his environment may 
suggest. His thoughts are therefore the reflection of his surround- 
ings, and he is like his thoughts. 



20 PUBLIC SANITATION AND OTHER PAPERS 



^DISEASE BY PERSONAL CONTACT. 

It is agreed by all hygienists that personal contact with those who 
are diseased is one of the most certain means of inducing its spread. 
This is more clearly recognized in regard to venereal diseases than in 
other cases of sickness. Indeed, there is a general belief that gonor- 
rhea and syphilis are practically always transmitted by personal con- 
tact, and usually in cases of sexual connection. While this may 
usually be the case, it is certainly not always true. 

Intrinsically, there is no reason why gonorrhea, at any rate, may 
not be transmitted by an intermediate object as readily as scarlet 
fever, and there is certainly no evidence that the same statement may 
not truthfully be made of syphilis. Gonorrhea is not only a very 
common disease among infants, but is one of the most serious with 
which the physician has to cope. Not only may the infant become in- 
fected at the time of birth, but the disease is readily transmitted by 
the careless nurse in many different ways. Napkins, thermometers, 
wash rags, nursing bottles, and in fact anything which may pass from 
one infant to another may be the means of carrying this dread disease. 

In many hospitals devoted to the care of infants, vaginitis spreads 
with alarming rapidity from one female child to another, and in many 
cases it is hence considered that the bath tub is responsible for this 
rapid spread of disease. The public towel is certainly an abomination 
which should be eliminated, as a person suffering from eyes affected 
by the gonococcus may easily leave the germs upon the towel and thus 
infect almost any number of people who afterwards might use it. 
There is good reason for believing that the organism producing 
syphilis is not so readily transmitted by intermediate objects; it also 
seems probable that this organism does not live for any length of time 
outside of the human body. Still, anything used by the syphilitic 
patient should be regarded with greatest suspicion; and cups, glasses, 
pipes, toilet articles, and in fact everything used by him should either 
be thoroughly disinfected before being used by anyone else, or, better 
still, destroyed. 

We have of late years learned so much of the possibility of disease 
germs being carried by fomites, that there is danger of our overlook- 
ing the dangers arising from personal contact. In every department 

*Jour. A. O. A., March, 1913. 



DISEASE BY PERSONAL CONTACT 21 

of life we find ourselves blinded to large numbers of facts by having 
our attention especially directed to a single thing; seeing that one 
thing frequently blinds us to everything else. While amebic dysentery 
is usually contracted through intermediate objects (polluted water 
and vegetables grown by irrigation), there are some cases recorded 
where it seems almost certain that the disease has been transmitted by 
personal contact. An uncleanly mother may easily transmit this disease 
to her baby by means of unclean fingers. Bacillary dysentery is also 
readily transmitted by unclean habits associated with the toilet. One 
interesting case is reported where a physician acquired this disease 
from first having infected his eye. Tears ran copiously from the in- 
fected eye, and some of these were swallowed, thereby conveying the 
bacilli to the alimentary tract. 

The careful study which cholera has received in recent years has 
convinced close observers that much of the cholera prevalent in the 
Orient is closely associated with the uncleanly habits of the people. 
Dirt and disease not only begin with the same letter, but more and 
more we are impressed with their close association and relationship 
to each other. "Dirt" is derived from the old Anglo-Saxon word 
"drit," and in its primitive meaning, this meant excrement, and in 
my statement in regard to dirt and disease I use the word in its origi- 
nal significance. In spite of all the work which has been in the line 
of popular education and in spite of the extent of our knowledge in 
regard to typhoid fever, we still have in the United States nearly two 
hundred thousand cases each year. At least 3 per cent, of these cases 
become "carriers" for a period of at least three years. This means a 
constant population in the United States of eighteen thousand well 
people who are in danger of transmitting typhoid fever to those w r ith 
whom they are associated, and when 25 per cent, of those recovering 
from the disease who are at least temporary carriers shall be added 
to this number, it is easy to see that those capable of transmitting 
typhoid fever are by no means few. No one should undertake to 
minimize the danger from contaminated water, milk or vegetables, 
and while no one should underestimate the danger arising from the 
filthy housefly, these things should not blind us to the dangers arising 
from personal contact. The following quotation from Dr. Sedgewich 
pretty well illustrates the whole matter, and I believe the inferences 
to be drawn from this quotation are in little danger of being ex- 
aggerated. In speaking of a certain city, he says : 

"Children abound; and as there are no fences, and because it is 



22 PUBLIC SANITATION AND OTHER PAPERS 

the custom, they mingle freely, playing together and passing from 
house to house. The families are of that grade in which food always 
stands upon the table; meals are irregular except for those who must 
obey the factory bell. The children play awhile, then visit the privies, 
and with unwashed hands, finger the food upon the table. Then they 
eat awhile and return to play. Or, changing the order of things, they 
play in the dirt and eat and run to the privy, then eat, play and eat 
again, and this in various houses and in various privies. For them, 
so long as they are friendly, all things are common — dirt, dinners and 
privies ; and, to illustrate exactly how secondary infection may go on, 
I may describe in detail one case which I personally witnessed: A 
whole family (of six or more) was in one room. Four of them had 
the 'fever.' Two of these were children in the prodromal stage. A 
table stood by the window covered with food, prominent among which 
was a big piece of cake. It was early September, and a very warm 
day; but every window was shut and the odor sickening. Flies in- 
numerable buzzed about, resting now on the sick people, now on the 
food. A kind-hearted neighbor was tending the baby. By and by 
one of the children having the fever withdrew to the privy, probably 
suffering with diarrhea, but soon returning, slouched over the food, 
drove away some of the flies, and fingered the cake listlessly, finally 
breaking off a piece, but not eating it. Stirred by this example, another 
child slid from his seat in a half-stupid way, moved to the table, and, 
taking the same cake in both hands, bit off a piece and swallowed it. 
The first boy had not washed his hands and if the second boy suffered 
from secondary infection, I could not wonder at it. 

"This was one case; but I have seen so often the table of food 
standing hours long in the kitchen, and serving as one station in the 
dirty round of lives like these, that it is easy for me to understand 
how dirt, diarrhea and dinner too often get sadly confused. The 
privies had been obviously in bad condition, and, from some, filthy 
streams ran down between them and the houses. In and around these 
streams the children played. Given any original imported case, the 
infection might easily have reached these trickling streams. Children's 
fingers might thence carry the germs to the food, and thus the journey 
of the germs from one living intestine to another be completed. Or, 
again, given in such a community, an imported case and no disinfec- 
tion, as was the condition here at first. The importer, while in the 
early stages, handles with unclean hands food for others ; or the cloth- 
ing of such a person gets infected and is handled ; there need be, then, 



DISEASE BY PERSONAL CONTACT 23 

no difficulty in completing the history. It follows as a matter of 
course." 

One reason why the danger of contact infection has been disre- 
garded is because typhoid fever has been looked upon as a purely in- 
testinal disease. There is now good reason for believing that there 
may be many cases of typhoid fever in which the intestinal tract is not 
seriously involved. Typhoid fever appears frequently to be a general 
infection of the body, and it is highly probable that the bacilli gain 
their entrance to the blood through the throat and the upper portions 
of the alimentary canal. 



Even a very superficial reader cannot help being impressed with 
the remarkably chaotic state of modern medical science (so-called). 
We pick up one health journal and we are gravely told of the ease with 
which the most inexperienced mother can safely pick out the drug most 
befitting the ills from which her child is suffering. We pick up an- 
other, and we are told that while drugs may be good, they must only 
be used by the most experienced physicians. The drug that is recom- 
mended by one is denounced as a vile poison by another. When we 
read these contradictory opinions, we feel like paraphrasing the old 
prophet, who, when disgusted with the numerous plans men had de- 
vised to please their god, raised the question: "What more doth the 
Lord require of a man than that he shall deal justly, love mercy and 
walk humbly with his God ?" and so we are ready to inquire what more 
it is possible to do to restore health or keep health than to intelligently 
conform to the laws of our being, and by this we mean, to live in a 
proper environment internally and externally, eat simple food and eat 
in moderation, sleep in well-ventilated rooms, keep ourselves free from 
the debilitating passions of envy, malice, spite and jealousy, and to feel 
that we indeed have a work which no other can do and that we must 
do it both for our own welfare and for the welfare of the world. He 
who lives in this way will not have much time or much need for dis- 
puting over the merits or demerits of drugs. 



24 PUBLIC SANITATION AND OTHER PAPERS 



-THE SPREAD OF DISEASE BY CARRIERS. 

One of the most important discoveries of recent times along the 
line of public hygiene is the discovery of the fact that a person may 
carry upon his person, or within his person, pathogenic bacteria, with- 
out himself suffering at all from the disease which they are capable of 
producing. The discovery of this fact was made a good many years 
ago, but its full significance was not understood until comparatively 
recently. The person capable of carrying these organisms is now 
popularly known as a "carrier," and recent investigations have shown 
that these so-called carriers may be the means of disseminating a large 
number of different kinds of pathogenic bacteria. 

Meningitis. — The disease known as cerebrospinal meningitis has 
been recognized as a distinct disease for many years, and it has been 
known for twenty years or more that one of the more virulent forms 
of this disease is produced by a bacterium known as the micrococcus 
meningitidis, but until recently it has not been known how this organism 
is passed from one person to another. Recent investigations have 
shown that when one suffers from this disease these organisms are 
abundant in the nasal secretion, and there are at least three ways in 
which the organism may be introduced into the meningeal membranes. 
One way is undoubtedly from the nostrils through the cribriform por- 
tion of the ethmoid bone ; another means is through the tonsils into the 
general circulation; and still another means is by the organism being 
swallowed and passing from the alimentary canal into the general cir- 
culation. There are so many cases in which the organism has been 
recovered from the blood that it seems reasonably certain that infec- 
tion is very frequently through one or the other or both of the last 
two mentioned ways. There are many cases in which the micrococcus 
is found in the nasal secretions, without a person showing any indi- 
cations whatever of the disease, and in many cases which have been 
carefully watched, the person thus harboring the organisms never 
develops the disease ; in many other cases the organism seems to cause 
a more or less severe rhinitis or pharyngitis. A German bacteriologist 
— Keifer — suffered from a severe attack of rhinitis, which was traced 
directly to an infection by the micrococcus meningitidis, with which 
he was at the time working. 

A few years ago there was a violent outbreak of meningitis in the 

*Jour. A. O. A., Nov., 1912. 



THE SPREAD OF DISEASE BY CARRIERS 25 

city of Bonn. Careful bacteriological examinations showed that out 
of 173 fathers of families, who were examined, 60 were carriers of the 
micrococcus, although they had no symptoms of the disease; out of 
153 mothers, who were examined, 39 were found to be carriers; and 
out of 478 children examined, 118 were carriers, although none of them 
ever developed any of the symptoms of meningitis. The worst of the 
matter is that the carriers may continue as such for months at a time, 
and no means have yet been discovered whereby the organisms may 
successfully be eradicated from the system. Almost always if not 
quite without exception, carriers are those who have been in close com- 
munication with the sick. The greater the number of cases of the 
disease in a community, the greater is the number of carriers. Carriers 
are especially dangerous in spreading disease, as it is comparatively 
seldom that they are recognized as being carriers, and when they are, 
it so often happens that their entire freedom from any indication of 
disease makes it practically impossible to place them under restraint. 

Our modern knowledge of carriers enables us to understand why 
it is that it so often happens that the disease breaks out in a house 
after a most thorough disinfection. Recent studies which have been 
made of meningitis seem to indicate that those who have the disease may 
almost be regarded as the victims of accident, as the number suffering 
from the disease always appears to be small compared with the number 
who carry the micrococcus without ever developing any of the symp- 
toms of meningitis. Incidentally it may not be without interest to 
mention that the micrococcus is almost specific to the meningeal mem- 
branes, as these never become infected without producing serious re- 
sults, whereas the infection of other parts of the body is far from 
producing specific results. The number of carriers of the pneumococ- 
cus is undoubtedly vastly greater than the number of carriers of the 
meningococcus. 

Diphtheria. — In 1884 LoefBer first recognized the fact that a per- 
son may carry in his respiratory passages the bacillus diphtheriae with- 
out suffering from diphtheria. In an outbreak of diphtheria in Glas- 
gow, Scotland, a few years ago, it was found that nearly ten per cent. 
of those who came in contact with patients suffering with diphtheria 
became carriers, although the number who developed the clinical symp- 
toms of the disease was comparatively small. Another thing which 
complicates diphtheria is the fact that so many scarlet fever patients 
also have diphtheria, and the child who has recovered from scarlet 



26 PUBLIC SANITATION AND OTHER PAPERS 

fever, and has been allowed to return to school, may be a menace be- 
cause of his being a "carrier" of diphtheria. 

Dr. Jacobi, of New York, was one of the first to recognize the 
great number of atypical cases of diphtheria. He was one of the first 
to call attention to a mild type of diphtheria, in which the diagnosis 
of the condition is extremely difficult. More than twenty-five years 
ago he said of this disease: "The symptoms are often few — a little 
muscular pain and difficult deglutition are perhaps all that is com- 
plained of. Women will quietly bear it; men will go to their business. 
There is as much bacteria out of the body as in the body, and nearly 
as much out of doors as in doors. Many a mild case is walking the 
streets for weeks without caring or thinking that some of his victims 
have been wept over before he was quite well himself. Diphtheria is 
contagious. Severe forms may beget severe forms, or mild forms; a 
mild case may beget mild or severe cases." Both rhinitis and otitis 
may be due to diphtheretic infection, and as these are frequently not 
regarded as true cases of diphtheria, such patients may readily become 
a menace to all around them. 

Typhoid Fever. — There are few who have read recent medical 
literature to any extent who have not heard of "Typhoid Mary." 
While this woman is in the enjoyment of continued good health, ex- 
perience has shown that she is a menace to any family of which she 
becomes a member; in other words she is a continual "carrier" of the 
bacillus typhosis. Were she the only carrier of this organism, the case 
would not be as bad as it is when we know that large numbers of 
people are carriers, and that most of them are entirely unsuspected as 
being such. 

Really the only way for people to protect themselves against ty- 
phoid fever is for every member of a family to act as he would act if he 
knew that he was constantly infected with the germs of this disease. 
When a "carrier" follows any occupation which makes it necessary 
for him to handle human food, he becomes particularly dangerous. 
A careless milkman, who is a "carrier," may be the means of spreading 
typhoid fever far and wide. 

Tuberculosis. — It has long been known that persons may be tuber- 
cular without seriously suffering from the effects of their infection, but 
in many cases, while the patient may not suffer he is at the same time 
capable of communicating disease to others, and if his habits are at all 
careless, he thus becomes more or less of a menace to those with whom 
he is associated. If there is the slightest reason for suspecting that 



THE SPREAD OF DISEASE BY CARRIERS 27 

one may have latent tubercular infection there is every reason for ex- 
pecting him, and even requiring him, to act with the great care which 
should characterize one who is the known victim of this disease. 

Gonorrhea. — Few diseases are more terrible in their ultimate 
consequence than gonorrhea. This is especially true when the victim 
is a female. In the male there is a marked tendency for the disease 
to ultimately lose its acute character and assume either a chronic form 
or become absolutely latent. When it assumes the latter condition, 
not only the patient himself, but his physician frequently supposes him 
to be free from the disease, and so far as he is personally concerned he 
may some times be regarded as being in this condition; but the tragic 
fact is that when the disease is latent in the patient, it may still be 
easily communicated to some unsuspecting victim, and in this way a 
life may be completely wrecked. There are many vaunted "cures" for 
gonorrhea, and some of these unquestionably leave a patient in a much 
better condition than he was before he was treated, but until we shall 
know more than we now know of the ultimate effect of this treatment, 
everyone who has ever had this disease should be regarded as a "car- 
rier" and treated as such. If this were done and if the conscience of 
the patient himself could be properly developed, it would save a greater 
amount of suffering than can be imagined by anyone who has not had 
an opportunity to attend a gynecological clinic in some of the large 
cities. 

Summary. — I will sum up this article on "infection by contact" 
by saying that the danger of adults contracting disease from each 
other by contact is much less than is the danger of children contract- 
ing disease by contact, and that while reasonable precaution should be 
used by people to avoid becoming carriers, a still greater precaution 
should be used by known "carriers" not to communicate disease. It is 
probable that we are fully justified in the complete separation of the 
child "carrier" from his schoolmates, for in the close contact of the 
school room, and with ventilation as imperfect as it frequently is, and 
with the lowered vitality consequent upon this imperfect ventilation, 
it is very easy for disease to be communicated from one child to 
another. 



When we come to a standstill we are in danger of assuming that 
the world is doing the same, but this is not true. We can keep up 
with the general progress only by constant activity. 



28 PUBLIC SANITATION AND OTHER PAPERS 



-CLEANLINESS AND ISOLATION. 

In following out the line of thought presented in last month's 
issue, it seems proper to refer to the dangers arising from the hook- 
worm. This worm has long been recognized in many parts of Europe 
as a dangerous parasite, but it is only in recent years that we have 
become cognizant of its presence in the United States. There seems 
to be much good reason for believing that the inefficiency of the so- 
called "poor whites" of the South is largely due to the presence of this 
worm. It is found throughout the small intestine of those people who 
are unfortunate enough to harbor it, and it gains entrance to the human 
body in a rather roundabout way. 

The worm itself (Anchylostoma duodenalis) is a nematode worm 
about one-half inch in length. Its numerous eggs are discharged in 
the contents of the alimentary canal, and unless fecal matter from the 
patient is taken care of by a deep vault, cess pool or sewer, the worms 
are likely to get into the damp ground over which fecal matter may 
be scattered. When the ground is at all damp, these worms keep near 
the surface, and if there is a possibility of their entering the human 
body through bare feet or through other parts coming in close con- 
tact with the ground, they do so. It is easy to see how half-naked 
children, playing upon soil infected with these worms, may become 
their victims. It has long been known in the South that children 
playing under these conditions were subjected to a skin eruption which 
was known under various names — "ground itch" and "dew itch' r 
being two terms which were quite widely applied to this condition. 
This skin eruption is now known to be due to these minute worms 
burrowing through the skin, and in this way they ultimately enter the 
blood vessels. When they are carried to the lungs, they leave the blood 
vessels and enter the air spaces. From here they make their way 
through the trachea to the pharynx. Here they are swallowed and 
quickly passed through the stomach, reaching their permanent home 
in the small intestine. 

With the life history of these worms before us, the problem of 
preventing their entrance into the human body is comparatively sim- 
ple. Like most other preventive measures, it simply means cleanliness, 
written in big letters. It means that all excrement from the human 
body is dangerous and that it must be disposed of in such a way as 
to not contaminate the general surface of the ground. It means a 

*Jour. A. O. A., April, 1913. 



CLEANLINESS AND ISOLATION 29 

satisfactory closet and cesspool, where sewers are not practicable. The 
small cost of satisfactory appliances amounts to very little, when com- 
pared with the sickness and inefficiency which results from a lack of 
these things. It is an old proverb that "poor people have poor ways," 
and it is a profound truth that poor ways often make poor people. 
Nowhere is this truth brought more clearly to our minds than in the 
hookworm section of our country. It is uncertain how far north the 
hookworm may live, but it is quite probable that, with imperfect sani- 
tation, its range may be greatly extended. 

One does not require a very deep experience in life in order to 
recognize the fact that we are all, to a greater or less extent, the vic- 
tims of self-hypnotization. In other words, when w T e become possessed 
of one idea that seems to effectually shut out the possibility of other 
lines of thought. We of this generation have become thoroughly im- 
bued with a sense of the dangers from air-borne diseases, and it is 
difficult for us to realize that there are other means by which disease 
may be transmitted, and that these other means may be as important, 
or even more important, than the air. People who refuse to walk on 
the same side of the street as that on which there is a smallpox patient, 
or who will go a block to avoid passing on even the opposite side of 
the street, seem to have little fear of drinking from a public cup which 
may have been recently used by a patient suffering from smallpox or 
from even a more serious disorder. People, upon the whole, are not 
cleanly, and this applies in some degree even to those who intend to 
be extremely cleanly. With the exception of private dwellings and the 
higher grade of hotels, toilet rooms are, as a general thing, extremely 
unclean. Fingers, food and feces are not a pleasant combination to 
contemplate, and yet a careful bacteriological examination shows that 
they are by no means a rare combination. It is probable that the pres- 
ence of fecal matter is faithfully indicated by the colon bacillus, and 
there are comparatively few places in the ordinary toilet room from 
which this bacillus cannot be secured. It is very certain that a con- 
siderable number of the bacteria producing communicable diseases are 
found in fecal matter. Fingers are a common means for the wide 
spread of saliva, and in the saliva of the sick the bacteria of disease 
may frequently be found. The fingers of the cook, the waiter, the 
milkman, the street-car conductor, and the book reader, pass rapidly 
from the mouth to the various objects handled. In this way saliva 
becomes almost universally present, and so is, of course, always ready 
to be transmitted to the mouth and the skin of anyone using his fingers. 



30 PUBLIC SANITATION AND OTHER PAPERS 

Even if it is true that most of the pathogenic bacteria die quickly, a 
fresh supply of saliva is almost universally present, containing those 
which retain their vitality for at least a few hours. Unless the cook is 
unusually cleanly and unusually conscientious, his fingers pass quickly 
from his mouth to the articles of food which he is preparing. The 
waiter, from the usually uncleanly toilet of the ordinary restaurant, is 
soon distributing food, which he handles with his fingers, to the gen- 
eral public. If the waiter picks up a glass to refill it with water, he 
not infrequently puts one or more of his fingers inside of the glass. 
The book reader not infrequently moistens his fingers to aid him in 
turning over the pages of the book which he reads. In doing this, he 
conveys the saliva of the last reader to his own mouth and leaves a 
supply in the book for the next reader. The hands of the milkman 
are almost certain to come into close contact with the milk. Certainly, 
in many cases bacteria in this way must be transmitted to the milk. 
Until very recently the public drinking cup was common on the cars, 
in the hotel and in the school. A careful worker recently found 20,000 
epithelium cells, probably from the mouth, in one cup which was in 
use in a public school building. 

Children, as a general thing, are entirely devoid of any sense of 
cleanliness, and it is a rather significant fact that children's diseases 
are most common among children before the sense of cleanliness has 
developed. Babies, as a general thing, are not brought into very close 
contact with each other, and it is well known that they are not nearly 
so subject to the diseases of childhood as are children between the ages 
of two and ten years. Before the age of two years, they do not come 
in close contact with each other, and by the age of ten, some ideas in 
regard to cleanliness begin to show development, but between the ages 
named, apples, pencils, strings, and toys of all kinds, are regarded as 
absolutely common property, and it is between these ages that child- 
ren's diseases are most readily transmitted. 

It seems that diseases are not spread so readily in hotels and lodg- 
ing houses as might be anticipated. I have just had a little personal 
experience which strikingly illustrates the fact. Several children 
afflicted with measles recently came to a hotel over which I had juris- 
diction as a health officer. The children were at once isolated in their 
rooms, and although they were separated from several hundred guests 
only by partitions, and although nurses of necessity passed in and out 
of the rooms to a limited extent, the disease was not communicated to 
any other person in the house. If this is true of a disease as easily 



CLEANLINESS AND ISOLATION 31 

communicated as measles, there is no reason for supposing that other 
diseases may not be as certainly restricted. Statistics show that in 
Providence, R. L, of 4,306 families living in houses occupied in com- 
mon with other families, scarlet fever was communicated from one 
family to another in only 295 cases — that is, 6.8 per cent, were trans- 
mitted to others, although the families to some extent used common 
toilets and bathrooms. In the same city, statistics show that 3,667 
families living under the same conditions suffered from diphtheria, but 
the disease was communicated to other families in only 263 instances — 
that is, 7.2 per cent, of the families transmitted the disease to others 
with whom they were so closely associated. Statistics of this kind 
should not serve to make us careless in using every precaution which 
can be used to prevent the spread of disease, but these statistics should 
serve to keep us from being hysterical when we are brought into close 
contact with those who are suffering from communicable disease. 

There are a few rules in regard to personal habits which should 
be impressed upon every child early in life. It is probable that others 
might profitably be added to this list, but I am venturing to present 
the following: 

1. If necessary to spit, always spit on the ground; 

2. Keep fingers out of the mouth; 

3. Use handkerchief for all nasal secretions. Never wipe the 
nose on the hand or the sleeve; 

4. Never put pencils in the mouth or wet them at the lips; 

5. Never hold money in the mouth ; 

6. Never hold pins in the mouth ; 

7. Never exchange half-eaten food of any kind, nor toys which 
are placed in the mouth ; 

8. Never breathe or cough in any person's face; 

9. Wash hands carefully before eating any kind of food. 



It should always be remembered that there is no such thing as a 
"cure" in the whole world. No matter what the condition of a patient 
may be, if he recovers from disease he must always recover from 
forces inherent in his body, and not from extraneous matter intro- 
duced from the outside. 



32 PUBLIC SANITATION AND OTHER PAPERS 



INFECTION FROM FOMITES. 

In previous papers we have strongly insisted upon the readiness 
with which many diseases are communicated by personal contact, and 
we have expressed doubt in regard to disease being readily transmit- 
ted by fomites or intermediate objects. By personal contact is not 
necessarily meant one person touching another, but a cup upon whose 
rim there is fresh saliva, a book which is immediately passed from one 
person to another, a napkin which is moist from the mouth of one per- 
son when used by another, are all, from a practical standpoint, neces- 
sarily or quite identical with personal contact. Any of these things 
allowed to stand for any considerable length of time become fomites. 
Those toys which are gathered from families where there have been 
cases of communicable disease, and carried to other families in a dis- 
tant part of the city, or carried to another city, act as fomites. The same 
thing is true in regard to blankets and books, hides of animals shipped 
from one place to another, etc. 

Years ago, the evidence that disease was widely communicated by 
these things seemed so conclusive that one would hardly care to ques- 
tion its possibility, and yet we know that many of those views were 
wholly erroneous. In a number of cases, it seemed very certain that 
material brought in from Cuba communicated yellow fever to the in- 
habitants of southern cities, and yet at the present time there seems to 
be good reason for believing that the disease is communicated almost, 
if not quite entirely, by mosquitoes. The same ship in which blankets 
or food stuffs were brought in undoubtedly afforded passage to the 
mosquitoes which were wholly unobserved, but which really consti- 
tuted the sole factor for the communication of the disease. The belief 
in the transmission of disease by fomites is by no means modern. If one 
will take the trouble to read the 47th to 59th verses in the 13th chapter 
of Leviticus, he will find a detailed account of the methods to be pur- 
sued in preventing the spread of leprosy by means of linen and woolen 
garments. The methods described here are not in strict harmony with 
our present views, but at the time this account was written, it is evi- 
dent that people had some practical acquaintance with what we con- 
sider the modern science of bacteriology. 

In 1908, Dr. Butler, in an English journal, told at some length 
of a parlor maid living in a hospital, who for some months came in 
daily contact with nurses having charge of scarlet fever patients, with- 

*Jour. A. O. A„ June, 1913. 



INFECTION FROM FOMITES 33 

out contracting the disease, but who quickly contracted the disease 
when she came into direct contact with a person suffering from it. Of 
course, isolated cases of this kind prove nothing, but the fact that 
physicians in most communities observe little precaution in passing 
from acute cases to others, and the fact that there is seldom reason for 
believing that they communicate disease, leads me to suspect that in- 
fection by fomites is much less common than is generally supposed. I 
have recently had personal experience with a somewhat widespread 
epidemic of measles. In a number of cases, bed clothing from the beds 
occupied by patients was sent to the laundry without having been 
sterilized in any way. Not unnaturally, I was considerably troubled, 
fearing that it might lead to an outbreak of measles among the em- 
ployees of the laundry, but to my relief, not one case developed. Tuber- 
culosis among laundry workers is by no means rare, but it is by no 
means certain that these cases come from direct infection from cloth- 
ing sent to the laundry. It would hardly do to jump to the conclusion, 
from what has been said, that disease may not be communicated by 
fomites, or that all precautions should be dropped, but our common, 
every-day experience, when carefully analyzed, is quite enough to lead 
sensible people to do away with hysterical fear of this kind of infec- 
tion. While I believe that the danger from rooms in which diseased 
people have lived is very small, it would not lead me to be any less care- 
ful in regard to fumigation, for when every possible precaution is 
taken, experience still shows that disease is readily transmitted. There 
is a tenement house district in New York City which has acquired the 
name of "the lung block." It has derived this name from the fact that 
a large percentage of its inhabitants are tubercular. The health author- 
ities of New York City have certainly exercised every possible care so 
far as fumigation and ordinary sanitary precautions are concerned, to 
prevent the spread of disease in this region, and yet the percentage of 
tubercular people is not appreciably diminished. The explanation ap- 
pears to me to be that the disease is communicated largely from one 
person directly to another. Of course, if it were not for the fumigation 
and other precautions which are taken, it is not improbable that a much 
larger percentage of people might be affected. Numerous outbreaks 
of small-pox in paper mills have been attributed to the rags from which 
the paper was made, but when one comes to carefully analyze these 
cases, it is certainly evident that there are other ways in which the dis- 
ease might have been acquired. There was at one time great fear that 
rugs brought from the Orient might be the means of introducing 



34 PUBLIC SANITATION AND OTHER PAPERS 

cholera and bubonic plague into this country and Europe, but so far 
as the best health authorities know, there is no case where the disease 
has been introduced in this way. We are from time to time treated 
to a scare in regard to the danger of money being a carrier of disease, 
but there is no evidence to show that clerks and other employees in our 
large banks suffer more frequently from infectious diseases than do 
those engaged in other kinds of employment. It must be writ large by 
the public hygienist that persons, and not things, are dangerous. 

It is very certain that tetanus is readily transmitted by fomites. 
The bacillus of tetanus is an unusually resistant form. Careful work- 
ers report that it may be in boiling water for an hour without being 
destroyed. The spores of anthrax are also highly resistant. In fact, 
there is a close relationship between the danger of spreading disease by 
fomites and spore bearing bacteria, diseases due to spore bearing bac- 
teria being much more likely to be communicated. Pathogenic bac- 
teria which do not produce spores are usually soon destroyed by drying 
and sunlight, although diphtheria is somewhat of an exception to this 
rule, as it is reported that these have been kept alive when dry for a 
period of five months. 

In conclusion, let me say that there is danger that the popular 
mind is now so firmly fixed upon the dangerous character of fomites 
that we are somewhat blind to other and perhaps more dangerous 
methods of communicating disease. If a person communicates disease 
to those with whom he comes in contact, it is quite likely that he does 
this because he is a "carrier," as because his hair or clothing are 
infected. 



The "times which try men's souls" are times when real men are 
made, for it is then that men may act; and no manhood of any value 
ever was or ever can be developed without action and without 
responsibility. 



No person who loves progress fears investigation; there is no 
person who is a tyrant who does not fear it. 



INFECTIONS THROUGH THE AIR 35 



^INFECTIONS THROUGH THE AIR. 

It was commonly believed in the days immediately following the 
discovery of the relationship between bacteria and diseases, that the 
breath was a prolific source of infection and that many, if not all, of 
the germ diseases were readily communicated by means of the air. 
Scare pictures of various kinds were devised to impress upon people 
the way in which disease might be communicated. The tubercular per- 
son was often represented as breathing out of his mouth an innumera- 
ble host of dangerous and malicious looking bacteria. Pictures of this 
kind are certainly the result of a most vivid imagination, for it is very 
certain that in ordinary breathing it is practically impossible for bac- 
teria to leave the respiratory tract. Of course, in coughing, it is not 
unlikely that bacteria will be ejected on and in the particles of phlegm 
which may be expelled in the air. 

Malaria and yellow fever were both long believed to be air-borne 
diseases. This guess was a shrewd one, although the guessers were 
entirely wrong in regard to the special way in which the disease is 
carried. One is often interested and even amused to see how nearly 
people in the past have come to facts without after all getting a real 
glimpse of them. The medieval astronomer, who conceived of the 
earth as being carried around the sun in the hand of some mighty angel, 
came very near guessing at the law of gravitation, and yet he was im- 
measurably separated from the real truth. Evolution as taught by 
Greek philosophers in many respects closely approximates our ideas of 
today, and yet the underlying principles of the two systems of philoso- 
phy are as diverse as are the poles. As a matter of fact malaria and 
yellow fever are both air-borne diseases, but they are borne by the air 
because the air permits the passage of mosquitoes, by means of which 
these diseases are spread, and there is not the slightest reason for be- 
lieving that these diseases are ever spread in any other way. 

It was long believed that smallpox was borne by the air, and in 
English cities, as well as in American cities, it was observed that small- 
pox hospitals were frequently a center from which this disease radi- 
ated. In fact some physicians who loved statistics undertook to estab- 
lish a ratio between the number of patients having the disease and the 
distance at which the hospital infected the air. The only trouble with 
the mathematical formula which was deduced was that it did not work. 
Later and more careful observations show that there is little real dan- 



^Jour. A. O. A., July, 1913. 



36 PUBLIC SANITATION AND OTHER PAPERS 

ger of smallpox spreading through the air. Like so many other dis- 
eases, it is usually spread by personal contact. If it were a true air- 
borne disease, people living within the area which might be affected 
by a hospital should all be afflicted about the same time, but as a matter 
of fact those who were nearest the hospital are affected first, probably 
because they come in contact with the patients. The disease which they 
acquire in this way is readily transmitted to their neighbors, and so the 
circle grows. As air conditions are more carefully studied, it was found 
that the prevailing direction of the wind exercised no influence what- 
ever upon the direction in which the disease spreads. Certainly, if it 
were an air-borne disease, this would not be true. Statistics also show 
that the males are much more affected by this disease than are females. 
This is easily explained when we know that men are out, coming in con- 
tact with their fellows to a much greater extent than are women. 

An old idea, and one which dies hard, is that diphtheria and ty- 
phoid fever are filth diseases. Certainly I should not want to appear 
as the defender of filth and yet the fact remains that no one has yet 
been successful in tracing either of these diseases to what is commonly 
denominated as filth. By uncleanly living, poor sanitation, the resist- 
ance to these diseases may be greatly lowered and in that way people 
may be predisposed to them, but the germs of these diseases are vastly 
more likely to be communicated by close personal contact than in any 
other way. It not infrequently happens that patients suffering from 
these diseases may be in the same ward with those who do not have 
these diseases and yet if they have different nurses, in many cases, the 
diseases are not communicated. 

Infantile diarrhea appears to be an air-borne disease, but in reality 
the disease is communicated much more by bacteria which are on par- 
ticles of dust than it is by bacteria which are absolutely free in the air. 
Poliomyelitis created something of a scare in California during the 
summer of 1912, and all known precautions were taken to prevent the 
spread of this disease. Probably three cases out of five which were re- 
ported never existed, but there probably were a few genuine cases. It 
is still uncertain as to how the disease is spread, but much careful work 
which was done led physicians to believe that it is spread by means of 
a fly. The stable fly is not unlikely the offending insect. 

There is a possibility that both measles and scarlet fever are spread 
through the air, but when one remembers that these diseases are pre- 
eminently the diseases of children and that children come in extremely 
close contact with each other and that both of these diseases are readily 



THE COST OF CRIME 37 

communicated before the symptoms are very pronounced, it is not 
difficult to see that personal contact may be responsible in a vast major- 
ity of the cases in which this disease is spread. 

Experiments in regard to tuberculosis are conflicting, but it seems 
almost certain that this disease is communicated, not only by the 
droplets of sputum which may be expelled into the air, but also by dust 
which has been previously infected by sputum. The bacilli on dust 
may retain their vitality for a long time when shut away from the sun- 
light and fresh air. In museums, where living animals are kept, it has 
been demonstrated over and again that those kept near the floor are 
much more likely to contract tuberculosis than are those kept in cages 
near the top of the room. This is easily accounted for on the supposi- 
tion that those near the floor inhale more dust than those that are 
higher. Experiences of this kind simply show that infectious diseases 
may be transmitted by fomites, but it does not disprove the thought 
that contagious diseases are in the main communicated by personal 
contact rather than by intermediate objects. 



*THE COST OF CRIME. 



There are few taxes which society is obliged to pay which are so 
heavy and so grievous as the tax we pay for crime. Although the 
criminal has probably existed through all ages, there is really no good 
reason why he should continue to exist in the future. The various 
societies devoted to eugenics are teaching us that it is possible, with 
proper care, to breed better men and women. If this is possible it 
certainly should receive attention. No stock raiser thinks of perpetua- 
ting a herd of undersized and imperfectly developed cattle and we 
must learn that it is just as serious a mistake for society to permit the 
degenerates to furnish a part of the generation which is to be. We 
who are living today are only life tenants on the earth and it is clearly 
our duty to pass the world on to the next generation in a somewhat 
better condition than we found it. If future generations are to be im- 
proved a great deal is going to devolve upon the physician and we 
earnestly hope that members of our branch of the profession will give 
this important subject the attention to which its importance entitles it. 

*West. Ost., Jan., 1912. 



38 PUBLIC SANITATION AND OTHER PAPERS 



*FAILURE OF ISOLATION IN CONTAGIOUS DISEASES. 

There seems to be the best of reasons for believing that pathogenic 
bacteria do not develop to any marked extent outside of the animal 
body. A few of them are unquestionably saprophytes, but most of 
them, as before stated, are strictly parasitic in their habits. This be- 
ing true the question naturally arises as to how it is that diseases be- 
come so widely spread, and how is it and why is it that isolation fre- 
quently seems to accomplish so little in checking their devastations. 
The answer is probably to be found in the numerous mild atypical 
cases of disease which are now unrecognized, and which until recently 
were entirely unsuspected. Mild cases of diphtheria are by no means 
rare, and there are many cases of scarlet fever which are never recog- 
nized. The same may probably be said of small pox and of many 
other diseases. This being true it is evident that early and accurate 
diagnosis is a factor of great importance in preventing the spread of 
disease. 

While the bacteria from "carriers" may not be quite so dangerous 
as are the bacteria from more virulent cases, still the unrecognized 
"carrier" must always be a source of serious danger, and it helps us 
to understand why it is so difficult to "stamp out" disease. It was not 
many years ago that many public health officers believed that the end 
of many diseases was clearly in sight; that when laws should be a 
little more rigid and a little more easy to enforce, isolation would com- 
pletely solve the public health problem. Work which was not to be 
accomplished by isolation was certainly to be accomplished by the 
destruction of fomites, and by thorough fumigation. The time came 
when laws were more strict and when it was easier to enforce them 
and still many diseases continued to spread very much as they spread 
before the legal machinery was quite so much in the hands of the 
health officer. 

We are certainly not ready to pronounce isolation a failure, but 
no one can have very much to do with public sanitation without becom- 
ing convinced that in spite of rigid isolation diphtheria, meningitis and 
small pox spread in most unsuspected ways. In the light of modern 
knowledge three courses are possible in regard to isolation : The first 
is to do absolutely nothing; this is probably not wise and would not 
be tolerated by public opinion in any American city. The second is 
absolute isolation not only of every person suffering from disease, but 

*Jour. A. O. A., Feb., 1913. 



FAILURE OF ISOLATION IN CONTAGIOUS DISEASES 39 

of every one who can in any way act as a "carrier ;" the second course 
would be as difficult to enforce as would be the first. While public 
opinion and probably the best sanitarians would not sanction the first 
course, public opinion would certainly not permit the second, and so 
no matter what his private views may be the health officer is forced 
into a course intermediate between the two ; in other words, it is possi- 
ble for him to secure the isolation of those who are manifestly sick 
with a contageous disease, but it is not always so easy for him to hold 
these people in isolation as long as the real safety of the public de- 
mands. It often happens that the bacilli of diphtheria persist in throats 
of patients for weeks and even months after he has fully recovered 
from the disease. During all of this time he may act as a "carrier" of 
the disease and may cause its wide dissemination. Public opinion will 
sustain health officers in the isolation of patients so long as they are 
manifestly suffering from the disease, but few courts, if it came to 
actual trial, would sustain the health officer in holding the patient in 
isolation simply because there are some microscopic organisms found 
lurking in his throat. The same may be said of scarlet fever. So long 
as the patient is sick it is easy to keep him in isolation, but when the 
acute form of the disease has given place to a slight discharge from 
the ear, which does not seem to incapacitate the patient from any kind 
of work, neither the courts nor public opinion will take very kindly 
to his being shut up and subjected to all of the inconveniences of a rigid 
quarantine. 

The value of hospitals in preventing the spread of contageous 
disease is of more importance than is generally understood, but un- 
fortunately the class of people who would be benefited most by hospital 
privileges, and the people who are most in danger of spreading disease, 
are the ones who for financial reasons are less likely to go. There is 
little difficulty in sufficiently isolating wealthy patients to prevent their 
being a menace to others, but it is often impossible in a poor family to 
keep the sick member away from others to such an extent as to safe- 
guard the well members of the family, and when these contract disease 
they of course immediately become a menace to all with whom they 
come in contact. There is no preacher in the land who proclaims the 
Brotherhood of Man with such force as does the public hygienist. 
The poorest, the meanest and the most unimportant member of the 
community may readily become the means of disseminating disease 
among the richest and best, when he is not properly cared for. Woe 
: the community that fails to look after the welfare of its poorest 



40 PUBLIC SANITATION AND OTHER PAPERS 

members ! While isolation may not be as important as we once sup- 
posed it to be, it should be vigorously practiced among school children, 
particularly from the fact that children come into such extremely close 
contact with each other, and particularly from the fact that isolation 
can here be accomplished without working serious hardships upon 
those under quarantine. 



*THE HOUSE FLY. 



The time is close at hand when we must decide whether we are 
to have our usual quota of summer flies, or whether we shall be free 
from them. The choice lies with us. 

Flies seldom travel more than a quarter of a mile from the place 
where they are hatched, and they are invariably hatched in filth. The 
favorite place for the fly to lay her eggs is in horse manure, but in the 
absence of this, eggs may be laid in any mass of decomposing organic 
matter. Each fly lays about a hundred eggs at a time, and the batches 
are laid in rapid succession. The eggs hatch into small white maggots, 
six or seven hours after they are laid. They live in the maggot form 
for five or six days, when they pass into the pupae state. The pupae 
continue as pupae for about five days, when the shell bursts, when they 
emerge as full grown flies. In other words, in ordinary warm weather 
flies pass from the egg state to the mature form in about ten days. Any 
heap of decaying organic matter which is more than six days old is 
a fit breeding place for flies. I fix the limit at six days, as the pupae 
are found at the extreme bottom of the decaying mass, and may be left 
on the ground, even after a very thorough clean-up. 

If the people in our city care to be particularly clean in regard to 
their yards and to have all manure and rubbish of every kind removed 
at intervals not exceeding one week, we can keep our town absolutely 
free from these dangerous pests. On the other hand, one unclean 
place may become a center from which flies will radiate in every direc- 
tion. A movement in the line of a flyless town must necessarily be 
supported by the public opinion of the people at large. Would it not 
be worth while for us all to unite to secure this end ? 



r So. Pas. Rec, Mar., 1913. 



DIPTEROUS INSECTS — FLIES 41 



^DIPTEROUS INSECTS— FLIES. 

The house fly, or as Dr. Howard prefers to call it, the typhoid-fly, 
belongs to the order Diptera. This order of insects is especially distin- 
guished by their possessing two wings. A few of the more primitive 
members of this order are altogether wingless or lose their wings at 
an early stage of their development. 

The order Diptera contains more than fifty thousand species of 
insects, and at least seven thousand species are found in North America. 
The greater number of these have no very direct relationship to human 
welfare, but a few of them are of great importance, and, unfortunately, 
this importance is due to the harm which they are capable of doing. 

While the house-fly is not the most annoying member of this 
order, it is undoubtedly one of the most dangerous, and one of the 
most difficult to deal with. This insect may complete the cycle of its 
life in somewhat less than twenty-five days, or in cold weather, its life 
cycle may extend over considerably more time. Like most of the 
other Diptera, it passes through four well defined stages of develop- 
ment: First, the egg is laid, preferably in the compost of the horse 
stable. The egg soon hatches into the larva or maggot. The maggot 
is a small white worm-like looking creature, which at first is devoid 
even of a mouth, and depends for its nourishment upon what can be 
absorbed through its skin. The larval stage is succeeded by the pupa 
stage. During the pupa state, the fly is enclosed in a hard and dry 
case and it is while it is enclosed in this case that it undergoes the 
series of transformations by means of which it eventually comes out 
from the case a perfect fly. 

Contrary to the prevalent idea, the fly does not increase in size 
after it emerges from the pupa, and the small flies, which are so fre- 
quently seen resembling the house fly, are entirely different species of in- 
sects. The mouth parts of the house fly are blunt and are entirely unfit 
for piercing the skin of any animal. Hence, this fly is never a blood 
sucker. All kinds of human food, as well as almost every description 
of filth, furnishes food for this insect. It is due to the latter circum- 
stance that great danger arises from the house fly, as the germs of 
disease in various kinds of filth are readily transferred to human food, 
and thus arises the danger of human infection. This is so particularly 
true in regard to the germs of typhoid fever that Dr. Howard of 

*Jour. A. O. A., Oct., 1913. 



42 PUBLIC SANITATION AND OTHER PAPERS 

Washington suggests, as stated above, that the insect shall henceforth 
be known as the "typhoid fly." 

A fly which resembles so closely the house fly that it is often 
mistaken for this insect is the stable fly. In fair weather, stable flies 
roam the fields far and wide in search of animals whose hides they may 
pierce and whose blood they may suck. While the mouth parts of this 
fly are on the same general plan as the mouth parts of the house fly, 
they are so modified as to eminently fit it for piercing the skin and 
thus sucking the blood. It is often remarked by country people that 
"a rain may be expected because the flies bite so hard." Careful ob- 
servation shows that the biting is done by the stable fly, which quickly 
seeks shelter as soon as climatic conditions presage a storm. 

The house fly almost invariable passes its infancy in the compost 
around stables or in the excrement of animals, whereas the stable fly 
passes its larval stage in decaying vegetable matter, or straw stacks, 
heaps of decaying weeds, et cetera. Under favorable conditions, the 
stable fly reaches maturity about twenty-five days after the &gg is laid. 
In very warm weather this period may be somewhat shortened, and 
on the other hand, in cold weather it may be considerably prolonged. 

Another fly which closely resembles the house fly and the stable 
fly in general appearance, but which is gigantic in size as compared 
with these insects, is the horse fly. This large fly spends its infancy 
in water, coming out of that only when it has reached maturity. Like 
the stable fly, it is pre-eminently a biting or sucking fly, and a few of 
them are enough to drive horses into a state of frenzy. The horse fly 
completes its cycle of development in about the same time as does the 
house fly and stable fly. It is only the female horse fly that has an 
appetite for blood, and like its small relative, the mosquito, is quite 
unable to lay eggs until it has fed several times upon blood. The male 
horse fly is a strict vegetarian and seldom leaves the vegetable 
growths around water courses. 

Another fly which is widely known, but which many people con- 
fuse with some stage of the house fly's development, is the blow-fly. 
The eggs of this insect hatch within the body of the mother, and so 
the young maggots pass from the body of the mother directly to the 
meat on which they are deposited. The fact that the blow-fly is guided 
solely by the sense of smell is shown by the fly depositing its larvae 
upon a perfectly bare surface, providing the surface has the odor of 
decomposing meat. The blow-fly completes its development in about 
thirty days. 



DIPTEROUS INSECTS — FLIES 43 

The screw-worm fly is perhaps one of the most savage of the fly 
group. Its eggs are not infrequently laid around the nostrils of a liv- 
ing animal or a human being, and the young larvae quickly invade the 
nose. Unless the patient receives early and vigorous attention, it is 
likely to result disastrously to him, as the maggots are singularly 
voracious and rapidly destroy the tissue of the head. 

The bot-fly does not closely resemble in form or feature these 
other flies and both its appearance and the note emitted by its wings 
rather remind one of some of the stinging bees. It is probable that 
this partly accounts for the fact that the horse swallows the eggs of the 
fly, which are laid upon the hair of the horses' legs. Certainly the 
placing of the eggs upon the hair of the horse cannot be a matter of 
annoyance, but horses seem to fear being stung and so they bite furi- 
ously at the fly and in that way get the eggs into their mouths and 
swallow them. 

These flies develop in the stomach of the horse. The larval state 
is passed almost exclusively in the stomach and when they reach the 
pupa state, the inert organism becomes incorporated with the general 
debris of the alimentary canal and is thus passed from the body of 
the animal. The pupa thus deposited upon the ground, soon gives 
place to the adult fly, which finds its self in the pasture and under 
conditions most favorable for again depositing its eggs upon some vic- 
tim. Ordinarily, the bot-fly seems to do little harm to the horse in 
whose body it lives, but occasionally they become so numerous as to 
seriously affect the health of the animal and even to menace its life. 
The bot-fly requires almost exactly one year for its complete develop- 
ment. 

The warble-fly has a rather singular life history. The eggs of 
this insect are laid upon the mouth or upon the food eaten by cattle 
and almost immediately develope into larvae, which bore their way 
through the esophagus of the victim and eventually lodge immediately 
under the skin of the unfortunate cow or ox. The larvae remain in 
this position for nearly one year, when they come out full-grown flies, 
ready to once more begin their evil cycle of life. In many parts of 
the country the damage to hides is a most serious matter. 

The little onion-fly, which is highly destructive to this vegetable 
in many places, may here be passed over, after calling attention to the 
fact that it is one more member of the great order of Dipterous insects. 



44 PUBLIC SANITATION AND OTHER PAPERS 



*ABOLISH FLIES BY ABOLISHING FILTH. 

I have received several communications of late, some in writing 
and some verbal, in regard to the desirability of abolishing flies from 
our city. Many people smile at a proposition of this kind and seem to 
think that those who speak of it propose to abolish them by some kind 
of a city ordinance. Nothing of this kind is ever seriously contem- 
plated, but it is a fact that if we should do away with filth we would, 
at the same time, do away with flies. In other words, much filth, many 
flies; little filth, fewer flies; absolute cleanliness, no flies. 

All of this is because flies of necessity spend their larval state 
where there is sufficient food supply and the natural food of the infant 
fiy is decomposing organic matter. Around every stable there is al- 
ways the possibility of enough organic matter to furnish food for flies 
sufficient to stock a whole neighborhood. If all of the organic matter 
around stables was kept securely screened, or if lime or some cheap oil 
was freely sprinkled over it, it would do away with the possibility of 
its becoming the breeding place for flies. In fact, every kind of decay- 
ing matter should be looked upon as the possible home of myriads of 
young flies. 

It would be absolutely impossible to enforce in our city an ordi- 
nance sufficiently sweeping to do away with flies unless there was 
strong public sentiment among our people favoring such an attempt. 
Few cities are ready for a thing of this kind until several years have 
been spent in persistent, public education. When we shall take such 
a step we shall strike a most serious blow at all forms of communicable 
disease, and the increased health of the community and the diminution 
of the heavy tax which disease lays upon us will make the cost of 
cleanliness seem as nothing to us. A lock which saves the casket of 
diamonds from being stolen is very cheap to the owner of the jewels. 

If all of those who desire to better the condition of our city in this 
particular direction will unite, first, in cleaning up their own yards, 
and second, in trying to induce their neighbors to do the same, we will 
rapidly work into a flyless condition, and, as I said before, by so doing 
we shall greatly reduce all forms of communicable disease. 



*So. Pas. Rec, Aug., 1909. 



MOSQUITOES 45 



*MOSQUITOES. 

It is impossible to write of the dangers of mosquitoes without 
calling attention to the organism which we have every reason to be- 
lieve is distributed by this insect. I refer, of course, to the several 
forms of malarial parasites. It is not improbable that these organisms 
have played a very important part in the history of animal develop- 
ment. It would be going much too far in the realm of speculation to 
assert a belief that warm-blooded animals have been developed through 
the influence of these blood parasites, but it is barely possible that these 
parasites, or some near relative of them, have been the agents which 
have changed the history of the world by developing the so-called 
warm-blooded animals from cold-blooded animals. 

There are very few of the lower organisms which are not the vic- 
tims of blood parasites and in many cases, it is known, that the pres- 
ence of these parasites results in the production of a fever and that in 
some cases the fever is destructive to the parasites. Now, it is barely 
possible that warm-blooded animals have by natural selection been 
driven into a physiological fever which frees from the danger of many 
parasites to which they otherwise might be subject. If this is true, 
there is still a goodly list of parasites which have adapted themselves 
to the high temperature of mammals and are thus able to live in their 
bodies despite their high temperature. 

The malarial parasites are represented by at least three species : 
two of these have a cycle of development extending through forty-eight 
hours. These are the aestivo-autumnal parasites or the Plasmodium 
praecox, the benign Plasmodium vivax and the more serious Plasmo- 
dium malariae. Of these the Plasmodium praecox is the truly danger- 
ous form as this organism is responsible for the most malignant form 
of malaria. Plasmodium vivax causes the benign tertiary malaria, 
while the Plasmodium malariae causes the malaria which is intermedi- 
ate in its nature between the other two. 

All of these forms of Plasmodiums must spend a part of their life 
cycle in the body of the mosquito. It is not known that they ever in- 
habit the body of any other insect. In the body of the mosquito they 
pass through their sexual stage of reproduction and by the mosquito 
are again inoculated into the human body. 

It is by no means easy to recognize all forms of malaria by micro- 
scopical examination. The parasite begins to affect the human body 
when about one red corpuscle in one hundred thousand is infected. 

*Jour. A. O. A., Nov., 1913. 



46 PUBLIC SANITATION AND OTHER PAPERS 

This means that the average patient shows signs of infection when he 
harbors about one hundred fifty millions of these parasites. When 
one considers the enormous number of red corpuscles in the blood, 
careful calculation seems to show that, if the pathologist finds his para- 
sites at the rate of about one in fifteen minutes, it is about as good as 
can ordinarily be expected in the early stages of the disease. This 
means that the ordinary superficial examination which so many phy- 
sicians make is of little value in incipient cases of malaria. 

There is much difference of opinion as to how long an infection 
of malaria may last. Personally I am inclined to believe that when a 
person is once infected there is a possibility of the infection lasting 
during his entire life. It has been suspected that an infected mosquito 
may transmit its infection to the next generation through the egg, but 
this suspicion entirely lacks confirmation. 

While there are more than sixty species of mosquitoes in North 
America, there is reason to believe that only one of these is capable of 
conveying malaria, and these mosquitoes belong to the genus Ano- 
pheles. The untechnical observer will most readily recognize the 
Anopheles mosquito by its curious habit of alighting with its head 
pointing directly at the wall upon which it rests, while the more annoy- 
ing non-malaria-bearing Culex mosquito rests upon the wall with its 
body parallel to the surface. The Anopheles mosquito makes much 
less noise in flying. The female deposits from twenty-five to one hun- 
dred and twenty-five eggs on the water. The length of time required 
for these to develop into adults is subject to great variation. It is 
probable that few reach their full development in less than fifteen days. 

The male mosquito is a strict vegetarian and is seldom found far 
from water courses. It is believed that the female mosquito may under 
favorable conditions live about one month after reaching complete de- 
velopment. When we know that the mosquito must spend its larval 
period in water, it is not difficult to surmise that the best means of pro- 
tecting oneself against mosquitoes is to drain all ponds and do away 
with all standing water in which they develop. Where it is impossible 
to secure the complete abolition of standing water, the proper course 
seems to be to cover it with oil, as this effectually prevents the develop- 
ment of the mosquito. 

The monetary loss resulting from malaria in California is esti- 
mated at nearly three million dollars yearly and it is estimated on good 
authority that one town in the Sacramento Valley of not over four 
thousand population suffers a yearly loss of more than seventy-four 



MOSQUITOES 47 

thousand dollars from this disease. Such figures demonstrate to us 
the supreme importance of a determined fight being made against a 
disease which is so easily preventable. 

TICKS. 

One should not close an article of this kind on the Diptera with- 
out referring to the wingless and degraded ticks which are members 
of this order. They belong to the group which is known as pupipara. 
This group has received its name because of the fact that the egg is 
retained within the body of the mother until it hatches, and until the 
larva is ready to enter upon its pupa state. 

The ticks are widely distributed both geographically and zoologi- 
cally. There are few species of animals which are not infested by 
them to a greater or less degree, sheep and cattle especially suffering 
from their ravages. In the Southern states, the business of cattle 
raising has been most seriously interfered with because of the ticks. 
Not only do cows suffer because of the blood which they lose, but the 
pain and annoyance of the tick contributes largely to the unfitness of 
the cow for either milk or beef. But a careful study of the habits of 
the tick has made it so that we can say of them as we say of typhoid 
fever, "that they are more of a disgrace than a misfortune." Already 
more than one hundred and forty thousand square miles of the South 
have been freed from this pest. 

The life of the tick from the time the egg begins to develop until 
it is sufficiently matured to begin egg laying is about twenty-one days 
and the best method of eradicating them has been found to drive cows 
through a bath containing a solution of arsenic at intervals of not ex- 
ceeding twenty days. This bath is destructive to the ticks and does the 
cows no harm. 

Not only do the ticks suck the blood of cows and cause them pain, 
but they are the means of distributing the organism which causes 
Texas Fever, and strange to say, this organism when in the body of 
the tick, may be transferred by the eggs to the next generation. 

The wonderful success which is attending the efforts to destroy 
the tick pest is only another evidence of the value of the close scientific 
study which enables the naturalist to learn the life-history of the form 
of life he would destroy or control. 

FLEAS. 

Until recently, fleas had been regarded as members of the order 
Diptera. Just now they are placed in an order by themselves, but they 
are so closely related to the diptera that I shall conclude this article by 



48 PUBLIC SANITATION AND OTHER PAPERS 

calling attention to the fact that fleas are widely distributed among 
mammals and that many species of mammals harbor separate species 
of fleas. 

There are at least two disease conditions which are traced to the 
flea. It seems quite certain that a species of tape-worm, by no means 
uncommon in the cat, spends a part of its life cycle in the body of the 
flea and that the cat, by unwittingly swallowing the flea, reinfects 
itself with the tape-worm. 

There is also good reason for believing that the rat flea becomes 
infected with the Bubonic Plague bacillus when the rat upon which it 
lives has this disease and that it may, by being transferred to a cat, 
get upon human beings and in that way transmit the disease from the 
rat to the people whose house this troublesome rodent inhabits. 



*THE GUARDIAN ANGEL. 

In our moments of agony and despair, who of us has not longed 
for a guardian angel? If we have allowed ourselves to believe that 
such a thing could exist, we have perhaps thought of it as something 
so ethereal that it could have little relationship to our common daily 
life, but in a little magazine issued by the Metropolitan Life Insurance 
Company of New York we learn that we can all have a guardian angel 
in the form of a National Department of Health. In this little maga- 
zine we are told how this angel will care for us, guard us and protect 
us ; how it will prescribe medicines we should take and proscribe those 
we should not take. In short, it will relieve us of responsibility in re- 
gard to health, and all that it will demand of us is that we shall yield 
perfect obedience to its mandates. 

Surely, the little article is adroitly worded, and if ever a mortal 
stole the livery of heaven in which to serve the devil, we think it must 
be the author of these few paragraphs. Now, just as a matter of fact, 
we all want health and we all want security, but when we purchase 
even these great blessings by surrendering our liberty, we pay far too 
high a price. Throughout the ages tyrants have always bestowed their 
blessings upon the obedient, but the men and women who have been 
obedient to tyrants have not been the men and women who have made 
the world a better place in which to live. 

Just for the present we believe that the American people will pre- 
fer to get along without a guardian angel, and undertake to protect 
themselves. We may not be successful in all cases, but we will learn 
some important lessons from our failures. 

*Ed., West. Ost., April, 1911. 



MALARIA 49 



-MALARIA. 



Malaria is a disease which has been known for a long time and its 
cause and treatment have been discussed from almost prehistoric ages. 
In 1880, Dr. C. L. A. Laveran, a French army physician, stationed in 
Algiers, not only discovered the true nature of the disease, but discov- 
ered that a special species of mosquito was necessary for its transmis- 
sion from one person to another. This knowledge is now the common 
property of the world, and however interesting it may be from a scien- 
tific standpoint, it is hardly necessary to record it again in this journal. 
Indeed, it would be extremely difficult to write an article so elaborate 
that much new information would be given. My only excuse for offer- 
ing a few words on the subject of malaria is that there is a healthy 
tendency at the present time for people to move back to the country, 
and whoever can do anything toward relieving the congestion of our 
modern cities is indeed a benefactor of the race. Malaria is pre- 
eminently a rural disease and any measures which can be used to di- 
minish the liability to malaria diminishes one of the obstacles to coun- 
try life. 

Few people realize how serious this disease is. Statistics show 
that in 1909, one hundred and twelve people in California died as the 
direct result of this disease. It would be impossible to say how many 
perished indirectly from the same cause. The actual loss in dollars 
and cents to California during this year amounted to no less than 
$2,820,000. Almost all of this is preventable, and if we had nothing 
to consider aside from the monetary loss inflicted by the disease, there 
would be every reason why we should strive to eradicate it. 

As before stated and as is well known, malaria is due to a proto- 
zoan parasite which is carried from one person to another by means 
of certain species of mosquitoes. The disease is not inherent in these 
mosquitoes and they become carriers of the disease only when they 
have drawn blood from some person who is already infected. This 
being the case, two methods of preventing the spread at once suggest 
themselves. The first and best is the eradication of the mosquitoes. 
The second is for all persons who are suffering from malaria to be 
thoroughly screened away from the possibility of the visits of mos- 
quitoes. Were either or both of these methods effectively enforced, 
malaria would cease to be. 

The word malaria means "bad air," and long before the true nature 

*Jour. A. O. A., May, 1914. 



50 PUBLIC SANITATION AND OTHER PAPERS 

of the disease was known, it was thought that those who were exposed 
to air at night were especially liable to contract the disease. It is need- 
less to say that the danger arose entirely from the mosquitoes which 
flew at night and not from the much maligned "night air." When the 
parasite has been inoculated into the victim, a considerable time elapses 
before there are any indications of the disease. The patient does not, 
as a rule, experience the first "shake" until there is about one parasite 
to one hundred thousand red blood corpuscles, or until in the person of 
average weight the parasites have increased to about one hundred and 
fifty million. 

It would be out of place in this article to go into a lengthy de- 
scription of the several kinds of malarial parasites, as this information 
may be obtained from almost any of the standard works on medicine, 
but it may not be out of place to remind our readers that with the in- 
creasing trade with the Orient, we are rapidly introducing the per- 
nicious form of malaria into this country and that the proper way to 
combat this disease is by a nation-wide attack upon the mosquito. This 
attack will pay for itself many times over, not only in protecting us 
from disease but in bringing into use lands which otherwise would 
remain as swamps and which would produce little or nothing of value. 

Where drainage is absolutely impossible, the next best thing is to 
cover the water with a cheap oil. This prevents the breeding of mos- 
quitoes. In many places school children are organized into sanitary 
brigades, and they not only render much useful service in destroying 
mosquitoes, but they get their first lesson in the duties of the citizen. 
With wise and proper management, the mosquitoes may aid us in 
teaching not only lessons of natural history, but the higher and more 
important lessons of civic duties and so, like all other burdens which 
we have to carry, this one may be glorified and may become the means 
of great good. This is certainly one of the public movements with 
which physicians of our system of practice may properly identify 
themselves. 



It will be an unfortunate day for real medical progress when 
either the state or the national government shall recognize any medical 
system as pre-eminently the state or national system. Until we shall 
know more than we do now about the nature of disease and the best 
methods of treating disease, the interests of all concerned imperatively 
demand that we shall have freedom for all rational systems and special 
favors for none. 



BEDBUGS AND COCKROACHES 51 



*BEDBUGS AND COCKROACHES. 

The order Hemiptera is represented by at least five thousand 
species of insects in North America alone. It is probable that several 
other continents are nearly as rich in insects of this order as is North 
America. These insects are pre-eminently known as "bugs." The 
typical "bug" is a four-winged insect, the outer or sheath wings being 
membranous on their outer part and thick, like the sheath wings of the 
beetle, next to the body. Some of the insects of this order, however,, 
are nearly or quite wingless. 

The order Hemiptera is particularly rich in destructive and in- 
jurious insects. The Chinch bug is a member of this order, and while 
it is much less destructive now than it once was, it still causes serious 
destruction of corn and wheat in several parts of the country. The 
Aphids belong to this order. The same is true of the San Jose Scale, 
which is so terribly destructive to citrus fruit trees. The Phylloxera, 
which has exterminated grape vines in many places, is a Hemipteran. 
The "kissing bug," which by the way is no joke, but a serious reality, 
is a Hemipterous insect from one-half to two-thirds of an inch in 
length. This insect causes most painful and often serious injuries by 
driving its long, sharp beak into any object with which it may come in 
contact, and thus not only inflicting a severe wound but injecting poison 
into the object thus pierced. The Cicada, sometimes called the 
Seventeen-year Locust, is another true bug. This insect spends nearly 
seventeen years of its life in larval form. This larva lives in the ground 
among the roots of trees and plants doing comparatively little damage, 
but after spending seventeen years living in this way, it emerges from 
the ground in its imago state and spends a few weeks of life in the air 
and sunshine. During this time it lays its eggs on the branches of trees, 
stinging these branches and injecting a poison in them which causes 
them to die quickly and drop from the tree, thus carrying the eggs to 
the ground and making it easy for the larvae as they emerge from the 
eggs to burrow in the earth. 

A degenerate member of this order is the bedbug (Acanthia lectu- 
laria) . This small, flat insect is wingless or has wings represented only 
by small scales on the sides of its body. The female bedbug lays her 
eggs during the spring, depositing some two hundred eggs that are pro- 

*Jour. A. O. A., June, 1914. 



52 PUBLIC SANITATION AND OTHER PAPERS 

duced in lots of about fifty. These batches of eggs are all produced 
within a few days. The eggs hatch in about seven days and the young 
pass through their larval stage in a short time and reach maturity. As 
a general thing, only one brood is produced during the year. The pecu- 
liar odor of the bedbug is derived from glands which probably make 
the insect offensive to other insects which otherwise might destroy it. 
Aside from being a severe pest in biting people, the begbug is certainly 
one of the means whereby relapsing fever is transferred from one 
person to another. The last severe outbreak of this fever in the United 
States was in 1869, but occasional cases are known from time to time 
in our seaport cities. The proper remedy, first and above all, to employ 
against the bedbug is cleanliness. The abolition of the wooden bed- 
stead and the substitution of iron and brass beds, certainly go very far 
towards destroying the habitation of this detestable insect. If beds and 
the walls and floors of rooms become infected with these insects, it is 
probable that there is nothing better to use than a 1 :500 solution of 
corrosive sublimate in water. This generally will destroy not only 
the adults but also the unhatched eggs. Where it is practicable to use 
kerosene oil, substantially the same results may be obtained with this 
agent. The popular idea that bats bring bedbugs to the houses is 
fallacious, though it is true that bats, as well as mice, are frequently 
infected with a parasite closely related to the bedbug and resembling 
it so closely that uncritical observers have mistaken it for the unwelcome 
guest of the bed chamber. 

The order Orthoptera is founded upon the fact that the edges of 
the wings of these insects form a straight line when the wings are 
folded to rest. Many of the insects of this order are either singers or 
leapers, or both. Some of the Orthoptera are so musical that the 
Japanese keep them in their homes in cages for the sake of their songs. 
The grass hoppers and crickets are both singers and leapers. The cock- 
roach, which is a most detestable insect, belongs to this order. The 
ordinary lady of the house is almost insulted if you suggest the possi- 
bility of her kitchen being the habitation of the cockroach ; and, indeed, 
if one seeks during the day to find the insect, he may find it impossible 
to do so, but when all is still at night, he may find them coming forth 
in considerable numbers and enjoying a feast on scraps and crumbs 
which may remain in the kitchen. These insects are particularly 
troublesome on ship-board, and sailors who have come around the 
Horn to our harbors not infrequently wear gloves at night to prevent 
their nails being eaten off by these ferocious insects. The insect has 



SPORTS 53 

very strong jaws and it seems to especially prefer food which utilizes 
their strength. 

The cockroach lays its eggs throughout the year and it requires 
nearly one year for the young to undergo complete development. It 
can readily be seen that insects of this character may readily become 
the carriers of disease. Indeed, all infectious skin diseases are readily 
transmitted by the roach, and public and private safety require that 
these insects shall be exterminated so far as possible. The remedy to 
be employed against them is cleanliness and the closure of all cracks 
and crevices where it is possible for them to obtain shelter. 



*SPORTS. 

We believe that the time has come for a definite protest against 
the importance which is attached to sports at the present day. Some 
entire newspapers are devoted to sporting news, and a number of our 
large daily newspapers print entire departments devoted to reports of 
games. This tends to give the average young man an exaggerated 
idea of the importance of these things. It leads him to feel that it is 
a matter of real import as to who shall win in a game of baseball or 
football, or some other sport, and in this way his attention is drawn 
away from matters that are of vast moment to him. The story is told 
that when Alcibiades, the tyrant of Athens, meditated some unusually 
atrocious act, he first cut off his dog's tail, and while the people were 
discussing the mutilation of the dog, he accomplished his infamous 
purpose. There is a certain line of political tricksters at the present 
day who are quite willing that the average man shall be more inter- 
ested in baseball and football than he is in the effects of certain pro- 
visions in the charters of cities, and while the voter is eagerly discuss- 
ing which college team is most likely to win in the coming contest, 
charter amendments, far reaching in their importance, are accepted 
or rejected with little thought on the part of our people. 

I believe that we should train our young people to think of sport 
as being important only for sport's sake. It is important in a game 
of football that the game should be played vigorously and fairly. It 
is a matter of absolutely no importance as to which side shall win. 
A foot race between boys is good, but providing that both boys conduct 
the race in such a way that each gets healthful exercise, it is a matter 
of no importance as to who wins. If we are right in regard to these 
views, it is time that a public sentiment supporting them should be 
cultivated. 



r West. Ost., April, 1913. 



54 PUBLIC SANITATION AND OTHER PAPERS 



*THE SPOTTED FEVER TICK OF THE ROCKY MOUNTAINS. 

Before the advent of the white man to Montana it was a matter of 
common knowledge among the Indians of the Bitter Root Valley that 
they were subject to a severe and frequently fatal form of fever: it is 
also known that they thought the region where they were subject to this 
fever had very definite geographical boundaries. It is now known that 
the same disease is found not only in Montana, but also in Idaho, Ore- 
gon, Washington, Nevada, Utah, Wyoming, and Colorado, and to a 
limited extent in the northeastern corner of California. 

No scientific study of this disease was made until 1902. In that 
year Doctors Wilson and Chowning announced their belief that the 
wood-tick, which is common in the region in which this disease pre- 
vailed, was in some way the agent by means of which the disease is 
transmitted from one human being to another. Their belief was based 
upon three facts which they had observed ; the first was that in a large 
number of the cases of spotted fever, as the disease was commonly 
called, the patients were able to give a definite history of having suffered 
from the bite of a wood-tick; the second was that ticks are especially 
abundant in the region in which the disease may be contracted ; and the 
third fact was that the season of the year in which spotted fever was 
most common, was the season when the ticks were most active. 

The beliefs of these doctors remained without definite confirmation 
until 1905, in which year some careful experiments were made at 
Boise, Idaho. In these experiments it was definitely proven that not 
only human beings, but guinea pigs became infected with spotted 
fever when they were bitten by a tick which had previously been upon 
the body of a spotted fever patient. These experiments were repeated 
the next year, at the University of Chicago, by Dr. H. T. Ricketts, who 
seems to have been unaware of the work which had been done at Boise. 
His experiments confirmed the views which had been formed as the 
result of the work at Boise. Dr. Ricketts found that both the male 
and female tick are capable of transmitting the disease. He also found 
that the larval tick may not only acquire the disease and retain it through 
its moulting period, but that it may transmit the disease either while 
it is still in the larval state or after it has reached its adult condition. 
He also made the highly interesting and important discovery that if the 

*Jour. A. O. A., Jan., 1913. 



ROCKY MOUNTAIN SPOTTED FEVER TICK 55 

female tick became infected she may, through her eggs, transmit the 
infection to the next generation. 

Dr. Ricketts' experiments proved five important facts: First, 
guinea pigs and monkeys are susceptible to spotted fever ; second, larval 
ticks may become infected, either from inheritance from an infected 
female or from a human being, and they are then capable of transmitting 
the disease during any after part of their lives ; third, what is true of the 
tick during the larval stage is equally true during the nymphal stage; 
fourth, adult ticks are able to acquire the disease and to transmit it 
through their eggs to the succeeding generation; fifth, ticks capable 
of causing the infection are found in nature. 

Since the only known means by which this disease can be spread is 
by means of this particular tick (Dermacentor venustus) it follows that 
the area through which spotted fever may be spread must be coincident 
with the region inhabited by this particular tick. This fact has lead to 
a very careful study of the range of the tick, and it is found that it be- 
longs especially to the Rocky Mountain region. Denver appears to be 
on the extreme eastern border of the region which it inhabits. The 
tick is not known at all in Arizona, and there is only a very small part 
of Northern New Mexico where it is found. It is abundant in north- 
ern and central Utah, but is not found in the extreme south of that 
state. Western Nevada and all of California are free from this pest 
with the exception of a small part in the extreme northeastern part of 
the latter state. 

One of the remarkable features of spotted fever is the fact that the 
disease appears to be of widely different virulence in different localities. 
In Idaho the death rate varies from five to seven per cent. ; in Bitter 
Root Valley in Montana the death rate is said to be as high as seventy 
per cent. It is possible that the treatment which the victims of this 
disease receive may partially account for this wide variation in death 
rate. In Idaho there are at the present time about five hundred new 
cases each year, and from the whole area subject to spotted fever there 
are more than seven hundred and fifty cases each year. It is a matter 
of great importance to the State of Montana to have this disease care- 
fully studied and some means found for the protection of the people 
from its ravages, for while Bitter Root Valley and some other parts of 
the state subject to this disease, are from many standpoints desirable 
localities in which to live, settlers will not be very likely to go there 
while they are confronted by this serious danger. There are careful 
observations being prosecuted at the present time to determine just 



56 PUBLIC SANITATION AND OTHER PAPERS 

why it is that the disease has been so terribly virulent in the Bitter Root 
Valley. 

While the tick appears to be the unquestionable agent by means of 
which the disease is spread, it is probably needless to say that the tick 
is dangerous only when it has been in contact with a person suffering 
from the fever. One of the victims of this disease moving to a region 
where the disease has not yet appeared, but where the tick is abundant, 
may be the means of widely infecting ticks, and in that way make it 
possible to spread the disease. On the other hand, infected ticks may 
be transferred either by animals or by merchandise to regions where 
the disease has not yet appeared, and in that way the disease may be 
spread. It is evident that great care should be exercised in regard to 
all goods shipped from the Rocky Mountain region, and especially 
from regions where this disease has made its appearance. While there 
are a number of species of ticks inhabiting this region, there is, so far 
as known, but one species which attacks man, so this species is the only 
one which is of especial importance from the standpoint of public 
hygiene. 

It is not at all improbable that when the life history of the spotted 
fever tick shall be fully known, some easy means may be suggested 
for its control, if not for its complete destruction. 

It is needless to urge the point that the prevention of infection is 
much more important than is the means of treating this disease when 
once contracted, and the prevention of the disease is almost purely a 
biological problem. It is diseases of this kind which makes us feel the 
importance of the physician possessing an all-around education. It 
forces us to the belief that he should possess not only a broad knowledge 
of the human body as a basis, but that he must possess at least a partial 
knowledge of a wide range of more or less nearly allied subjects. 



Some people are still inclined to underestimate the importance of 
the etiology of disease. But the careful physician recognizes more 
and more that not only is his treatment of disease influenced by its 
etiology, but that he is powerless to aid in the prevention of the spread 
of disease unless he is fully acquainted with its cause. Only a few 
years ago whole cities suffering from yellow fever were placed under 
quarantine. Now we know that the yellow fever patient may be cared 
for without danger to the nurse, providing care is taken to exclude 
mosquitoes which might spread the disease. 



THE PROTOZOAN 57 



*THE PROTOZOAN. 

The word Protozoan means the first or most primitive form of 
animals. The true Protozoan consists of only a single cell, although 
some of the animals placed in this group live in communities which 
closely approach the condition of a multicellular animal. It is by study- 
ing some of these grouped forms that one is enabled to get a conception 
of the way in which the multicellular animals arose from the unicellular 
forms. Not many of the unicellular animals are extremely complex in 
structure, and while they are able to boast of only one cell, still within 
the boundaries of this cell may be found contracting vacuoles, a more or 
less distinct alimentary tract, an occasional spot which appears to be 
sensitive to light, and in some cases structures which are capable of pro- 
ducing phosphoresence. 

Of the hundreds of known Protozoa only a few are known to ever 
live either within or upon the human body, and of the few which are 
human parasites a very small proportion is injurious. One of the in- 
jurious forms is the Amoeba dysenteriae. This parasite is from twenty 
to fifty microns in diameter. It is usually mononuclear, although the 
nucleus occasionally becomes fragmented. The protoplasm is granular 
and the cell wall is imperfectly, or not at all, developed. When this 
Amoeba becomes parasitic in the human body it is usually found in the 
wall of the colon, where it may be the cause of very serious, and some- 
times, absolutely fatal illness. The patient suffering from an attack 
usually has a very severe dysentery. After the solid material in the 
alimentary canal has been ejected, the movements of the bowels consist 
of a watery secretion in which there is a mingling of more or less blood 
and mucus. It is from the latter that a positive diagnosis of conditions 
may be made. 

For this purpose the mucus should be lightly washed with water 
and then spread on a warm slide and examined with a moderately low 
power objective. One-quarter to one-sixth-inch objectives are likely 
to give the best results. If Amoebae are present, they can usually be 
detected in the mucus by their slow amoeboid movements. If the slide 
upon which the examination is made is not warm, there is danger that 
the Amoebae will be quiescent, in which case it is very difficult to dis- 
tinguish them from disintegrating epithelial cells. If for any reason 
they are not found in the first examination, another examination from 
a subsequent movement of the bowels should be made. Cases are not 

*Jour. A. 0. A., April, 1914. 



58 PUBLIC SANITATION AND OTHER PAPERS 

infrequently recorded where the Amoeba is found in large numbers 
in the pus discharged from an abscess of the liver. 

The relationship of the Amoebae to the abscess is somewhat prob- 
lematical, but until we have more evidence to the contrary, it appears 
probable that the abscess is due to an infection of this animal. Wherever 
the infection of this Protozoan may be, it is to be regarded as a serious 
matter. An infection of the liver is especially difficult to treat, not 
only because the organ is inaccessible, but also because it frequently 
happens that the nature of the infection is only known as a result of 
post mortem examinations. When the colon is infected, the result is 
what is known as tropical or pernicious dysentery. 

It is no part of my plan in this department to discuss treatment, 
and yet as I have had personal knowledge of several cases of this dan- 
gerous infection, I may perhaps be excused for saying that thorough 
and long continued washing of the colon with water enemas has yielded 
very satisfactory results. In the cases of which I have had knowledge, 
enemas have been continued for nearly or quite an hour at a time, and 
water by the tens of gallons has been injected and allowed to run out, 
as a result of which the parasites seem to have been washed away. 

Several other species of Amoebae are known to occasionally in- 
habit the alimentary canal, but I do not know of any reports which 
would lead one to attribute any serious results to them. It is almost 
certain that the Amoeba dysenteriae is conveyed from one person to 
another by polluted water. All water which can possibly be contami- 
nated with sewage is dangerous, not only for household purposes, but 
also for the purpose of irrigation where plants like lettuce, onions, 
radishes and other vegetations that are eaten uncooked are concerned. 
In one case of which I had personal knowledge, the infection seems 
to have occurred through milk vessels in which raw vegetables irri- 
gated by sewage had been washed. To make a long story short, I 
must again say that protection from this parasite is to be attained 
through cleanliness. 

Another Protozoan which is responsible for a serious infection 
is the Trypanosome gambiense. This is a flagellate protozoan belong- 
ing to the family Tryponsomidae. 

Aside from the organism which produces sleeping-sickness in 
human beings, there are several of the Trypanosomes which are serious 
pests to animals. The disease known as Nagana, which destroyed large 
numbers of wild animals in South Africa, is caused by a Trypanosome. 
Suria, which is rather common among the wild animals of India, is 



THE PROTOZOAN 59 

caused by another. Dourine, which affects horses in most warm 
countries, is a third. Cattle bane of South Africa is due to still another 
member of this evil genus and the Spirochaeta pallida, which causes 
human syphilis, is a closely related form of life. 

The infection caused by T. gambiense takes two forms. Both 
have been known for more than one hundred years. The first is char- 
acterized by severe anemia, emaciation, enlarged spleen and lymph 
nodes, together with great prostration; the second and more typical 
causes profound lethargy whence its popular name of sleeping-sick- 
ness. When the disease was first known, it was confined to a small 
area of country on the west coast of Africa, but with increased travel 
it has spread to the eastern coast, and is now by no means uncommon 
in the great fertile region around the head waters of the Nile river. 

The only known means of transfer of the Trypanosome from one 
person to another is by means of the fly known as the Glossina pal- 
palis or the Tse-tse fly. This fly belongs to the group of Dipterous 
insects and is a serious pest wherever it lives. A careful study of the 
life history of this fly suggests the natural means for control of sleep- 
ing-sickness. While the Tse-tse fly, like most other of the dipterous 
insects, is extremely prolific, it can produce its young only where it 
has access to running water. There is fortunately one other condition 
necessary for the development of this fly — a thick undergrowth of 
weeds and brush within three hundred feet of the edge of the stream. 
Violate the condition of running water with banks covered with under- 
brush, and the breeding of this fly becomes an impossibility. So, of 
course, the rational method for the control of this disease, is to keep the 
banks of streams clear of brush and high grasses. When this is done, 
the Tse-tse fly is abolished, and then the transmission of the Trypano- 
some becomes impossible. 

During the days of the slave trade, sleeping-sickness was by no 
means uncommon in our Southern States among the newly imported 
negroes, but because of the absence of the fly, the disease never be- 
came epidemic. When a person once becomes infected, the chances for 
his recovery are few indeed, so safety is almost entirely dependent 
upon avoiding infection. It may be of interest to our readers to men- 
tion the fact that as early as 1843 it was found that Trypanosomes were 
by no means uncommon in the blood of frogs and two years later they 
were discovered in the blood of rats. It is not known that either of 
these animals is capable of furnishing the means for human infection. 

It is examples of this kind which lead us to feel the extreme value 
of research institutions. The work of the explorer is nearly done, but 
the work of the sanitarian is still in its infancy. 



60 PUBLIC SANITATION AND OTHER PAPERS 



^PROTOZOAN DISEASES. 

Our increasing knowledge of the world in which we are living 
adds new force each day to the thought that every fact is in some way 
related to every other fact, and that he who would know one thing 
well must know something of everything. 

Anyone who will take the time to examine old files of catalogues 
of medical schools will see how slowly but surely the field of the physi- 
cian's education has enlarged. It is not many years ago that biology 
first became a part of the education of the physician. This subject was 
added to his curriculum not because any one supposed that it had a 
close relationship to his future work but because it was believed that a 
broader knowledge of life would add to his general culture and give 
him a broader outlook than he would otherwise possess. With in- 
creasing knowledge, however, it has been found that one can no more 
be an all-round physician without being a biologist than he could be a 
successful surveyor without a knowledge of mathematics. 

For the last twenty years or more the critical student of the human 
body has known that a considerable number of diseases are due to 
bacterial invasion of the body. For a somewhat less length of time he 
has known that bacteria are more nearly related to vegetables than to 
animals. Until recently his attention has been so closely fixed upon 
those diseases known to be due to vegetable or bacterial invasion that 
he has given little or no heed to diseases which are caused by animal 
parasites. The investigations of the last ten years have thrown a won- 
derful flood of light upon a considerable number of tropical diseases 
of an infectious nature which are positively traced to animal organisms 
rather than to plant organisms. The animals producing these diseases 
belong to the sub-kingdom protozoa and they are characterized by be- 
ing unicellular in structure. A few of them may pass directly from 
one animal to another but the greater number of them spend a part of 
their lives in some intermediate host, and this host, in a considerable 
number of cases, is found to be some insect. 

Many of these protozoan diseases are extremely serious in their 
nature. In fact, most of them do not yield to any treatment with which 
we are at the present time acquainted, and it is by no means improbable 
that we shall eventually find that the only way to deal with them suc- 
cessfully is by prevention, and in order that we may intelligently pre- 

*Jour. A. O. A., Nov., 1910. 



PROTOZOAN DISEASES bl 

vent these diseases it is necessary that we should not only understand 
the nature of the organism producing the disease, but that we should 
thoroughly understand the life history of the intermediate host by 
means of which the organism is conveyed from one person to another. 
In coming to the Pacific Coast our eastern friends passed over hun- 
dreds of miles of plains which at one time were the home of herds of 
horses perhaps as numerous as were the buffaloes in the days of our 
fathers, and the place where we meet today was once inhabited by the 
mammoth, camel, and giant sloth and large numbers of other animals 
now extinct. What became of them? And why did they disappear 
from a region which appears to have been so favorable for their lives? 
Many answers have been given to this question but until comparatively 
recently none of them rested upon anything more substantial than 
speculation. 

A few years ago there was found in the shale of some of the late 
geological deposits of the Pacific Coast remains of a Tse-tse fly. The 
species is not exactly the same as that which renders parts of Africa 
uninhabitable today but a species closely allied to that dread insect. 
The evil of this insect consists not in itself, for it is probably no more 
annoying than many other insects, but it acts as the intermediate host 
of the protozoan parasite which is absolutely fatal to the animals in- 
fected with it. In other words, an explanation of the disappearance 
of those great animals which were once so abundant may be that they 
were destroyed by the protozoan parasites with which they were inocu- 
lated by insects, in very much the same way that animals and people 
are inoculated at the present day. 

There are now considerable parts of Africa absolutely uninhabit- 
able for the horse, dog and cow, and there are other parts which have 
long been known as the "white man's grave," and all of this not from 
any "miasm" or inherent unhealthfulness of climate but solely from 
protozoans which are conveyed by insects. 

It is said upon good authority that malaria is the great scourge 
of the human race and that more people die from malaria than from 
any other disease. As one form of malaria, at any rate, is a disease 
with which we are all of us more or less familiar, I am going to follow 
through with some care the life history of the malarial parasite, and 
we may properly regard this as being typical of all protozoan parasites 
which have a host intermediate between the human victims. 

In this case the protozoan host is a mosquito, belonging to the 
genus Anopheles. It is a curious fact that if the malarial parasite is 



62 PUBLIC SANITATION AND OTHER PAPERS 

taken into the body of the common mosquito (Culex) it is straightway- 
digested and thereby killed. 

In giving the life history of the malarial parasite, it is perhaps 
best to begin with it in the human blood. In the human blood the 
malarial parasite first appears as a minute gelatinous mass, belonging 
to the group of protozoans known as the sporozoa. It is quite possible 
that the organism producing both smallpox and scarlet fever belong to 
the same group, though this is not positively known. This gelatinous 
mass in the human blood soon buries itself in a blood corpuscle and in 
this red corpuscle it undergoes cell division, producing from 6 to 12 
new dividuals. These are extruded in the general blood stream and 
like the original mass soon embed themselves in blood corpuscles where 
the process of reproduction either by sporulation or cell division is re- 
peated. In this way the number of parasites repeatedly increases, and 
in common tertian malaria in about two weeks' time they have reached 
such numbers as to seriously affect the health of the individual harbor- 
ing them. If the blood of the patient is drawn and is exposed to a 
lowered temperature, many of these parasites undergo a marked change. 
Processes resembling pseudopodia (or false feet) are rapidly shot out 
from the protoplasmic masses. These become easily detached from the 
parent mass and for a short time they display a remarkable vitality. 
If they come in contact with other malarial parasites which do not 
produce pseudopodia, the pseudopodia are readily absorbed by these. 
Of course, when this occurs in an ordinary drop of blood drawn from 
the body, it is of no significance, whatever, but if the parasite is taken 
into the body of the Anopheles mosquito similar changes occur and 
this is full of significance. The pseudopodia which form on malarial 
parasites in the body of the mosquito are really gametes, or true male 
cells and their union with non-pseudopodia producing parasites results 
in true fertilization. This sporulation in the body of the mosquito is 
soon followed by a rapid self-division of the fertilized individuals and 
the parasites thus formed, by passing through the tissues of the mos- 
quito, work their way into glands whose secretion is forced into the 
human being whose blood the mosquito sucks. In this way the cycle 
of the parasite's life is completed and it is ready to begin again. 

It has been suggested by some very able biologists that the action 
of these blood parasites has been of far-reaching significance in the 
history of animal life; that not only have they caused the destruction 
of large groups of animals but that they have been the means of 
forcing cold blooded animals, or animals whose temperatures are sub- 



PROTOZOAN DISEASES 63 

ject to continual variation, into a fever which has become physiologi- 
cal. In other words, that they possibly give us a clue as to how warm 
blooded animals may have developed from those whose temperatures 
was subjected to variation. Whatever may be the value of this specu- 
lation, the fact remains that the blood parasites have had a remarkably 
wide distribution, both in time and space. We have positive evidence 
that animals in the tertiary geological period suffered from them, and 
they certainly belt the earth with a girdle extending almost from one 
frigid zone to the other. It is estimated that five million people perish 
every year in India from pernicious malaria, and there are at least two 
million new cases which develop each year in Italy with a death rate 
of fifteen thousand annually. 

The protozoan producing amoebic dystentery belongs to the group 
Sarcodina. As I have already discussed this matter at some length 
I pass it at this time. 

Another protozoan group of wide-spread importance is the Masti- 
gophora. These unicellular organisms are characterized by possessing 
one or more flagella, by means of which they secure their locomotion. 
Sleeping sickness is due to one of these organisms. While the disease 
is largely confined to equatorial Africa, a few sporadic cases have been 
observed in the United States. The disease is due to the Trypanosoma 
gambiense, and, like several of its near relatives, which affect animals, 
it is conveyed by the Tse-tse fly. In other words, the Trypanosoma 
passes a part of its life in the human being and the rest of the cycle of 
its life in the Tse-tse fly. It is now a well known fact that while the 
large animals of Central Africa have become immune to the Trypano- 
soma our domestic animals are quickly destroyed by it. 

Syphilis appears to be produced by the spirochete (Treponema) 
pallidum, another member of the group Mastigophora. Still another 
member of this group is responsible for the tick fever, which is rapidly 
becoming a dreaded disease in Montana, Idaho and some of the other 
mountain states. At the request of the Department of Agriculture, I 
have made a somewhat careful examination of dairy cows in and 
around Los Angeles, but I have failed to find on them any of the ticks 
which form the intermediate host of the Trypanosoma producing the 
tick or mountain fever. 



In a multitude of blind men, one man who has only one eye will be 
king, and among medical practitioners the leaders must inevitably be 
those possessed of the best education. 



64 PUBLIC SANITATION AND OTHER PAPERS 



*AMOEBIC DYSENTERY. 

There are disadvantages as well as advantages in becoming a world 
power. One disadvantage is that world-wide commerce brings to our 
shores many diseases which we would have known only by name had 
our commerce been less extended. Among these diseases may be men- 
tioned Tropical Dysentery, or, as it is more commonly called, Amoebic 
Dysentery. Amoebic Dysentery is a disease of long standing in tropical 
and oriental regions. It is caused by the Amoeba dysenteriae. 
This is a protozoan belonging to the class Sarcodina and to 
the sub-class Rhizopoda. The Sarcodinae are the lowest forms 
of the Protozoans. They may be either naked or provided with a well- 
marked shell. They move by means of finger-like projections known as 
rays. The Rhizopods, like the class to which they belong, include both 
naked and shelled forms. The Amoeba is a naked organism and it 
looks not unlike a shapeless mass of jelly. While living at ordinary tem- 
peratures it gradually changes its shape. There are ten or more species 
of Amoebae, though the distinction between the species is not always 
very clearly marked. As before stated the organism which is believed 
to cause Tropical Dysentery is generally known as Amoeba dysenteriae, 
though some writers place it in a different genus and call it the En- 
tameba histolytica. The parasite is from 15 to 25 microns (3-5000 to 
1-1000 inches) in diameter and it is most readily found in the mucus 
passed from the bowels of patients suffering from Amoebic Dysentery. 

As the Amoeba may easily be mistaken for an epithelial cell, great 
care is necessary in making the laboratory examination. In six cases 
which I studied with great care last winter I found that methylene blue 
gives a very satisfactory stain, but in each case I made a positive diag- 
nosis only after finding living and moving forms. To find these the 
mucus must be fresh — not more than six hours old — (and fresher than 
that is better) and it must be examined on a warm stage in moderate 
light. They can be studied to great advantage with a 1^2 inch eye 
piece and a 1-10 inch objective, but they can be identified with some- 
what less magnification. They are described and figured in so many 
works on medicine that I forbear an extended description of the or- 
ganism. 

The Amoeba may inhabit both the large and small intestines as 
well as the cecum and sometimes the appendix. They may be carried 
by metastasis to the liver, the lungs, or indeed to almost any part of 

*Jour. A. O. A., Aug., 1909. 



AMOEBIC DYSENTERY 65 

the body, and in these new fields they may produce serious and even 
fatal abscesses. The abscess produced by Amoebae is usually inclined 
to burrow deeply and thus in the intestine may advance to the stage of 
complete perforation. When the Amoebae are carried to the 
liver an abscess may form which may eventually rupture either through 
the body wall, into the right lung, into the body cavity, into the stomach, 
into the colon where it touches the liver, or into the right kidney. In 
any of these cases the result is likely to be fatal. It sometimes requires 
a long series of examinations to prove positively the presence of 
Amoebae in the pus in an an abscess of this character. 

The disease is spread almost entirely by food or drink. The 
Amoebae are abundant in the feces of patients suffering from the 
disease and if water used for drinking or culinary purposes becomes 
contaminated in any way with this matter it is easy to see how it can 
act as a carrier. If water thus contaminated is used for the irrigation 
of green vegetables, it is easy to see how these may carry the disease. 

In a recent outbreak of the disease in Pasadena a careful analysis 
proved almost conclusively that the amoeba was brought into the house 
on green vegetables, — probably lettuce. The lettuce was washed in a 
dish pan in moderately warm water. The same dish pan was used, 
without scalding, to wash milk vessels which were not scalded but 
which were placed in the sun to dry. Milk was afterward placed in 
these vessels and it appeared that the Amoebae which were thus intro- 
duced into the milk reproduced themselves abundantly in the milk. 
That is, the milk acted as a culture medium, and in one sample which 
I examined the Amoebae were numerous in milk 12 hours old. So far 
as I have been able to ascertain this particular species of Amoebae is 
not a native of the United States but it has been brought here by per- 
sons who have become infected with it in its native habitat. We must 
expect an increasing number of persons suffering with this disease to 
come to our shores and scatter over the United States. Unless we 
protect ourselves, not only by good personal hygiene but also by public 
sanitation, we shall suffer severely from it. If there is one word in 
which is summed up protection against Amoebic Dysentery as well as 
Typhoid Fever, — and in fact most other diseases, — that word is "clean- 
liness." 

Until recently comparatively few small towns felt that they could 
afford the luxury of a sewer, but with our broader knowledge of the 
way in which diseases are spread, and our better appreciation of the 
cause of sickness, we should feel that a sewer is not a luxury but a 



66 PUBLIC SANITATION AND OTHER PAPERS 

necessity. Even from a cold-blooded standpoint of dollars and cents, 
sewers are very much cheaper than either funerals or prolonged cases 
of illness. A good cess-pool may indeed be regarded as a substitute for 
a sewer, but a truly good cess-pool is such a rarity that could one be 
found it should be put in a museum as a valuable specimen. They not 
only contaminate the ground for a considerable distance around them, 
but they are always subject to unexpected overflow. When this occurs 
it is needless to say that they are a serious menace. A cesspool in- 
fected with Amoeba dysenteriae might, by one overflow, endanger the 
entire neighborhood. 

If osteopaths are to occupy the place in the public mind which 
their interests demand, they must be alert in all matter relating to the 
general good, and their devotion to the art and science of treating 
disease must not prevent their close study of the great problems of 
public hygiene. 



*A STRANGE INTESTINAL MASS. 

Early in September of the present year a physician of this city 
sent an elongated mass, passed from the bowels of one of his patients 
(a man 60 years old) to the Histological Laboratory for examination. 
The mass was about equal to a lead pencil in diameter, and the total 
length passed was something more than a meter. The first appear- 
ance suggested some giant nematode worm, but a brief study of the 
object dispelled that view. 

A careful examination showed that the whole mass was composed 
of epithelial cells held together by mucin. Within this mass were large 
numbers of amoeba coli. 

It is impossible to say whether there is a causal connection be- 
tween these parasites and the epithelia-mucin mass or whether their 
presence in it is purely accidental. 

To what extent, if any, this amoeba is pathogenic is not known. 
The fact that it occurs regularly in certain forms of dysentery is 
strongly in favor of its being a pathogenic form. 



k The Osteopath, P. S. Q., Oct., 1900. 



A FEW HUMAN PARASITES 67 

*A FEW HUMAN PARASITES. 

Organic reproduction is far in excess of the possibilities of organic 
life, and because of this a constant struggle for existence is inevitable. 
These facts are now admitted by all competent naturalists. The strug- 
gle for an opportunity to live has caused every available nook and 
corner to be occupied by some form of life. 

"And there's never a leaf nor a blade too mean 
To be some happy creature's palace." 

In this life and death struggle some forms of life have depended 
upon their power to compete with their fellows in "open field and no 
favors." Others have sought to live because of their obscurity and be- 
cause they were in no one's way, or, if they were in the way, because 
they were inaccessible. Among mammals the lion lives because of his 
courage and strength ; the mole lives because he keeps out of the way. 
Among vertebrates the bee lives because of its courage and its high 
grade of intelligence, while the safety of the earth worm is based 
upon its security. 

In this general struggle for some place of abode we need not be 
surprised that some animals and plants have found a congenial home 
upon, or within, other animals or plants. 

These organic forms which live upon or within others, and more 
or less upon their food or tissues or upon both, without causing imme- 
diate death, are known as parasites. 

All forms of organic life are so closely linked together that it is 
by no means easy to point out the exact grades of parasitism. Profes- 
sor Van Beneden recognizes three grades of organic relationship. 

Animal messmates are those which live in such relationship with 
another as to secure a part of the food which the other animal had de- 
signed for himself. In other words he seizes for himself the food pro- 
vided for another. 

Many examples of messmates among marine animals might be 
cited. There are fish which habitually live in the mouths of other fish ; 
many species of Crustacea are found attached to fish and marine mam- 
mals, and worms are found upon the backs of crabs. In all of these 
cases the messmate does not injure the tissues of his host in the least, 
he simply eats the raw material which the host has provided for himself. 

After the messmate the next step toward parasitism is mutualism. 
The mutualist among animals is one which lives upon the body of 
another, but secures food without reference to the food of its host. 

Many insects are mutualists with birds and mammals. In some 

*The Osteopath, P. S. O., Oct., 1900. 



68 PUBLIC SANITATION AND OTHER PAPERS 

cases they feed upon the epidermal cells which are shed by the host 
and thus are an advantage to the animal which shelters them, but it is 
a very short step from feeding upon the dead epidermal scales, to feed- 
ing upon the tissues which are still living. When this is done we have 
a true parasite. 

Parasites which live upon the surface of the body are known as 
ectoparasites, while those which live within the body are endoparasites. 
The animal ectoparasites are mostly insects or their near allies, while 
most of the animal endoparasites are worms. 

There are two groups of worm which furnish human parasites. 
These are known as Platyhelminthes or flat worms, and Nemathelmin- 
thes or round worms. To the first division belong the tape-worms and 
flukes, and to the second the Ascaris and Trichina. 

Aside from the endoparasitic worms the human body may be in- 
fested with several unicellular animals and a very large number of uni- 
cellular plants. Among the most important of the latter are various 
species of bacteria. 

Of all the internal parasites tape-worms are the most widely known. 
Four different species are not infrequently found in the alimentary 
canal of man. These are the Taenia solium, Taenia saginata, Taenia 
nana, and the Bothriocephalus. 

All tape-worms have substantially the same life history. If we 
start with the mature worm in the alimentary canal of a human being 
it is found to consist of two. well marked parts ; a slender unsegmented 
part just back of the anterior enlargement which is known as the head, 
and by means of which it is fastened to the intestine, and a more or less 
elongated part distinctly segmented. Each of the segments is known 
as a proglottid, and it is capable of living an independent life for a short 
time after it is separated from the rest of the worm. Normally these 
proglottids break off from time to time and are expelled from the body 
of the host. As fast as the segments are separated from the worm, new 
ones are formed and this may go on indefinitely. Within each segment 
or proglottid are found the organs of generation, both ova and sperm 
being produced in each one. 

When the proglottids are expelled from the body they may move 
about to some extent, and as they are well filled with eggs before they 
detach themselves from the parent worm, every movement ejects eggs 
from them. If these eggs are swallowed by some animal, a pig or an 
ox, for example, they soon hatch in its alimentary canal; the embryo 
then bores its way through the intestinal walls and enters some muscle 



A FEW HUMAN PARASITES 69 

where it comes to rest, or it may enter a blood vessel and be carried to 
some distant part of the body. 

Wherever it comes to rest it rapidly increases in size and develops 
into what is known as a bladder worm or cysticercus. This foreign 
body is at once attacked by the white blood corpuscles or leucocytes, and 
since they cannot dissolve it they collect around it in great numbers 
and gradually become transformed into neutral tissue, thus shutting 
the worm up in an impervious sac. 

In this condition the worm remains until its host dies. If its flesh 
is then eaten by man, the bladder worm (if the meat is imperfectly 
cooked) may find its way to the stomach, and there the cyst enclosing it 
may be dissolved and the worm liberated. The worm thus set free 
quickly attaches itself to the wall of the intestine either by suckers or 
hooks and rapidly increases in length. The posterior end of its body 
now develops proglottids, and its curious life history is ready to repeat 
itself. 

The intermediate host of Taenia solium is usually the hog, though 
occasionally the larval worm is found in the sheep. Taenia saginata 
passes its intermediate stage in the flesh of the ox. The life history of 
Taenia nana, or dwarf tape-worm, is unknown. It probably passes its 
larval life in the body of some insect or possibly in some land snail, 
but how it gets from this host into the human body is a mystery. It 
may be that fragments of dead insects containing these larvae fall into 
food and are unconsciously swallowed. 

Bothriocephalus latus passes its larval stage in the body of a fish. 
It is said to infest the pike more frequently than other species. There 
are some other species of tape-worms occasionally found infesting man, 
but the four named are the most common ones. In this country Taenia 
saginata is by far the most common form. It may reach a length of 
twenty-five feet or more, and its effect upon its human host is very 
variable. In many cases no appreciable disturbance of the system re- 
sults, while in other cases most serious nervous and digestive complica- 
tions are observed. The safeguard against any and all of the tape- 
worms is never to partake of flesh which has not been thoroughly 
cooked. Great care should always be observed in handling tape-worms, 
as their eggs are very small and might easily be introduced into the 
body. Such an accident might be very serious, for, as already stated, 
the larval worm may find its way into the blood-vessels and in this 
way it might be carried to the brain or some other vital organ. 

The Distoma or liver-fluke is another flat worm which has been 



70 PUBLIC SANITATION AND OTHER PAPERS 

found in the human body, and which sometimes produces serious results. 

The life history of the worm suggests the best means of guarding 
against it. The mature fluke, which may be in the liver of a sheep, ox, 
or man, lays a great number of eggs which pass into the intestine with 
the bile and from there are expelled from the body. A single fluke may 
lay nearly half a million eggs. The embryo breaks from the eggs two 
or three weeks after they pass from the body of the host. If the eggs 
were dropped in a dry place the young worms quickly perish, but if 
the eggs fall into water the embryos swim about most actively for 
several hours. If during this time one comes in contact with a certain 
species of water snail it quickly bores its way into the snail's body and 
becomes encysted there. It is now known as a sporocyst. 

Certain cells develop in the sporocyst which give rise to separate 
animals, each of which is known as a redia. Each redia in its turn pro- 
duces, by means of unfertilized eggs, a large number of young, which 
are called cercariae. These wriggle out of the body of the snail into the 
water, and their future development depends upon their being swal- 
lowed by some animal in whose liver they can develope. 

It will be noted that water which can in any way be infected by 
flukes is extremely dangerous to drink, and any water which is in the 
least contaminated by either cattle or sheep is in serious danger of 
such infection. 

Among the Nemathelminthes, or flat worms, the Trichina spiralis 
is best known and is most dangerous. This worm is about one-twen- 
tieth of an inch long in its mature condition, and is about as large 
around as a hair. It may reach its mature state in the bodies of several 
different animals, but it must always live in the bodies of two individ- 
uals before it reaches maturity. 

Among domestic and semi-domestic animals it has been observed 
in the bodies of rats, chickens, cats and pigs. 

If we should start its life history with its living in the muscles of 
a rat, the worm would undergo no change until the death of the rat. 
If the rat should not be eaten, the Trichinae would perish when the 
flesh of the rat decomposed, but if the flesh of the rat should be eaten 
either by another rat, a cat or a pig, the cysts in which the worms were 
living would be dissolved in the stomach of the animal which ate it, 
and the worms would be set free. 

Up to this time the worms were larvae and were unable to pro- 
duce ova and sperm. Now, however, they quickly reach their sexual 
maturity, and they begin to produce eggs abundantly. 



A FEW HUMAN PARASITES 71 

While the mature worm never seeks to leave the alimentary 
canal of their host, the young worms immediately begin to bore out, 
and soon they are encysted in the muscles by the same process as that 
which encysts the tape-worms. If they are now encysted in the mus- 
cles of a pig they may easily be introduced into the human body by 
the flesh of the pig being eaten without being perfectly cooked. In 
the human stomach the cysts will be dissolved and the worms will re- 
produce freely, and the young will bore their way into the muscles. 
The symptoms closely resemble muscular rheumatism. The pain is 
intense, and unless it is modified in some way the patient is in great 
danger of dying. Whatever his fate may be, he may have the satis- 
faction of knowing that the Trichinae are hopelessly side-tracked, and 
that if his body meets the fate common to humanity, their doom is 
sealed. 

The Oxyurus vermicularis is a round worm, frequently found 
parasitic in children. The eggs are taken into the body either by drink- 
ing impure water or by eating food which is unclean. The eggs hatch 
in the stomach, but the worms pass on toward the lower portions of 
the intestine. Here they may occasion more or less trouble until they 
are expelled, when they quickly lay their numerous eggs and die. 

The life history of the Ascaris lumbricoides is very similar to that 
of the Oxyurus vermicularis, with the exception that the Ascaris 
spends a comparatively long life in the intestines, and its eggs which 
are laid frequently are discharged from the alimentary canal. In 
structure the Ascaris is the larger of the two worms. As the effect 
of tape-worms and of most round worms varies widely with different 
individuals, scarcely any two being affected in the same way, and as 
the symptoms indicating these parasites are obscure at best, we need 
not be surprised at the quackery which centers around them. In almost 
any city may be found some "Helminthologist" whose chief claim to 
public consideration lies in the fact that he is a Mexican or an Indian, 
even more ignorant of worms than of the human body, were such 
ignorance possible. I know of no stronger argument to use in urging 
the importance of everyone having an intelligent conception of the 
structure of the human body than the fact that the offices of these pre- 
tenders are frequently crowded with people who in some lines at any 
rate, are intelligent. 

If any one has any reason to suspect that he is afflicted with any 
kind of a parasite, the only safe thing to do is to consult an intelligent 
physician and submit to such treatment as he may deem best. 



72 PUBLIC SANITATION AND OTHER PAPERS 



*TAPEWORMS. 

The precise place which tapeworms occupy in Nature is not very 
well known even at the present time. By most zoologists they are 
placed in the great class of Vermes or Worms, but this division of the 
animal kingdom consists of a number of groups so imperfectly related 
to each other that it is not at all improbable that future zoologists will 
divide it into two or more co-equal divisions. 

As one studies the structure and life history of the tapeworm, one 
is almost forced to the conclusion that whatever it may be, it certainly 
is not a worm. It is impossible for us to form any clear conception 
of the ancestor from which this queer form of life has descended. It 
has been so modified by its parasitic habits that most of its original 
structures have disappeared. It is one of the comparatively few ani- 
mals which are entirely without organs of either offense or defense, 
and it is also entirely devoid of the power of locomotion. Its digestive 
system has completely disappeared and in its mature form it is little 
more than the home of a mass of organs necessary for the reproduct- 
ive function. Indeed, when its life history is told, one readily sees that 
if its capacity for reproduction was much less than it is, the race would 
inevitably perish. 

These parasites are usually not so disastrous to their hosts as one 
might at first suspect, and the popular idea that they consume food to 
the detriment of the patient is without foundation in fact. Were they 
so highly injurious as to cause the death of the host they themselves 
would be involved in ruin. Parasites of this kind tend toward a sym- 
biotic relationship with their host, that is a relationship of mutual 
helpfulness. So far as the tapeworm is concerned, however, symbiosis 
has been very imperfectly developed, as we have every reason to be- 
lieve that it is entirely useless to its host, although as before stated, 
most forms are not highly destructive. 

The life of the tapeworm presents such a cycle that it is by no 
means easy for one to determine where to begin to tell its story, but 
as people are best acquainted with it in its adult form, it will perhaps 
be as well to begin with this period of its life history. 

In this stage of its existence, the tapeworm consists of two pretty 
well defined parts; one of these parts is known as the scolex or head 
and the other part consists of the proglottides, which are continually 

*Jour. A. O. A., Dec, 1913. 



TAPEWORMS 73 

mistaken for its body. As a matter of fact, the so-called head repre- 
sents the entire worm and the proglottides are independent individuals 
which are budded off from the parent stalk. The proglottides occupy 
somewhat the same relationship to the scolex that the branches which 
might be cut from a willow tree to use as cuttings occupy to the tree 
from which they are derived. The proglottides are continually pro- 
duced by the scolex and those which are most remote from the scolex 
are the oldest. These proglottides consist of little more than repro- 
ductive units and in each one of them may be found both ovaries and 
testes. In other words, each proglottid is a hermaphroditic animal. 

In some species of tapeworms the proglottides have little or no 
power of motion. In others, they move with some degree of freedom 
when they are detached from the chain to which they originally be- 
longed. In all cases, the proglottides discharge their eggs in such a 
way that there is a possibility of the eggs being swallowed by some 
other animal, thus the proglottides or the eggs from the proglottides 
in the alimentary canal of the wolf are discharged in such places that 
deer or rabbits may inadvertently swallow the eggs when eating grass 
cr herbage. When an herbivorous animal (deer, rabbit, etc.) swallows 
one or more of these eggs, the egg hatches in its stomach and the 
resulting worm almost immediately passes through the walls of the 
stomach into the blood. The blood stream sweeps it to some peripheral 
part of the body where it leaves the blood vessels through the walls 
of capillaries and becomes encysted in the muscles or other tissues of 
its host. In this stage of its development, it is commonly known as a 
bladder-worm. It gets its name from the fact that attached to the 
body of worm which is to become the scolex, there is a large bladdery 
organ which is lost when it passes to a new host. Its passage to a 
new host is dependent upon the first host being eaten. In other words 
the rabbit which derived its bladder worms from eggs deposited from 
the body of the wolf, gives the worm back to the wolf when it, the 
rabbit, is eaten by the wolf. The bladder worm set free by the digest- 
ive fluids in the stomach of the wolf, passes to the intestines and there 
becomes attached to the wall of the alimentary canal by means of 
hooks which have developed upon the scolex, and here it rapidly de- 
velops into the adult form or the form which produces the proglottides. 
Thus it will be seen that the tapeworm ordinarily vibrates between two 
hosts. In the carnivorous host it reaches its highest degree of de- 
velopment and in the herbivorous host it lives as an encysted bladder 
worm. 



74 PUBLIC SANITATION AND OTHER PAPERS 

It is not easy to determine how many species of tapeworms have 
been described up to the present time. Owing to individual variation 
among them, it is not improbable that a single specie has been described 
under several different names and conversely there are some species 
which so closely resemble each other that it is not improbable that the 
same name has been applied to two forms which should bear different 
names. There are at least six different tapeworms which are known 
to infest the human body and it is highly probable that this number 
would be considerably increased if we were to enumerate forms which 
are occasionally or accidentally present in the body. 

One of the tapeworms well known to infest the body is known 
as the Taenia saginata. This tapeworm is not infrequently at least 
twenty-five feet in length. The scolex or head is about as large as the 
head of a medium sized pin. The proglottides of the mature worm 
are discharged freely from the human body, and when there is a possi- 
bility of these being swallowed with the grass eaten by the ox, they 
readily develop into the embryonic form in his body. The bladder 
worm of the Taenia saginata forms a cyst not much larger than a pea 
and as this embryo readily stands a high temperature, it may well hap- 
pen that the embryo may be introduced into the human alimentary 
canal when beef is eaten which has not been very thoroughly cooked. 
The mature form of this tapeworm may live for many years in the 
human alimentary canal, each year producing hundreds if not thous- 
ands of proglottides and each proglottid producing thousands of eggs. 
It is due to the enormous number of eggs thus produced that the pos- 
sibility of this worm continuing its life is dependent. The bladder 
worm form may live for years encysted in the muscles of the ox. 

The Taenia solium is a closely related form of tapeworm which 
spends its larval state in the muscles of the pig. Its life history is 
almost identical with the Taenia saginata. 

The Taenia echinococcus is a near relative of the two preceding 
worms, but unlike the others it spends its larval stage in the human 
body. Its mature form is found in the dog, wolf and other closely 
related carnivorous animals and its ordinary life history leads it through 
the sheep and ox during its larval period, but owing to the close rela- 
tionship between the dog and man, it sometimes happens that the 
human being unwittingly swallows these eggs. The Taenia echino- 
coccus differs from most of its relatives by the larva having the power 
oi reproduction by budding. Owing to this, a single egg may pro- 
duce a large colony of the larvae and the cyst which forms around 



TAPEWORMS 75 

this colony may be several inches in diameter. Because of this pecu- 
liarity, infection by the Taenia echinococcus is an extremely serious 
matter and when the cysts occur in the liver, as they not infrequently 
do, it may lead to early death. It is perhaps needless to say that when 
the larvae develop in the human body, they are hopelessly side- 
tracked so far as their own development is concerned, as the dog and 
wolf can continue the species only as they get the larvae from dead 
sheep or cattle. 

Another member of this genus is the Taenia eliptica, or as it is 
sometimes called, the Diphilidium caninum. This is one of the small- 
est tapeworms. Its length varies from five to eight inches and it is 
one-fourth to one-half of an inch in breadth. This worm normally 
spends its larval stage in the bodies of dog fleas and its mature stage 
in the alimentary canal of the dog. As the eggs are discharged from 
the alimentary canal of the dog, those which happen to adhere to the 
hairs of the dog's body, may be swallowed by fleas and the flea with 
the fully developed larva in its body may be swallowed by the dog 
when the flea causes too much irritation, and thus the cycle is com- 
pleted. It is easy to see how children playing with cats and dogs in- 
fested with these worms may unwittingly swallow the fleas and thus 
become infected with the mature worm. 

One of the most-to-be-dreaded of the tapeworms is the Dibothrio- 
cephalus latus. This is sometimes known as the fish tapeworm, as this 
worm spends its larval life in any one of several species of fish, and 
in countries where fish are eaten without being thoroughly cooked, the 
inhabitants are more or less infested with this worm. The Dibothrio- 
cephalus produces a severe form of anemia in its human host and it 
is not easy for the physician to determine the difference between 
anemia produced by this tapeworm and pernicious anemia. It will be 
readily seen that it is a matter of real importance to distinguish be- 
tween these two anemias, as the only treatment which is of any value 
for the tapeworm anemia is to get rid of the worm. If this is not 
done, there is at least a possibility that the patient may absolutely die. 
It is well to remember that most of the cases of infection by this tape- 
worm come to us from Europe and that infections seldom occur in 
this country. 

Another European tapeworm is the Hymenolepsis nana. This is 
the baby among the human tapeworms. It is not known that infec- 
tion ever occurs in this country. The worm in its mature form is 
only one and one-half inches in length and not more than three- 



76 PUBLIC SANITATION AND OTHER PAPERS 

quarters of an inch in breadth. Frequently it is very much smaller 
than either of these dimensions. There are about one hundred and 
fifty segments in its body and its life history is entirely unknown. 
Some of its victims manifest no well-defined symptoms, but others 
seem to suffer seriously from nervous complications. 

When one has experience in our larger clinics and notes the con- 
siderable number of people who are suffering from this very pre- 
ventable disorder, he becomes more strongly impressed than ever be- 
fore with the value, indeed, the absolute necessity of preventive medi- 
cine. The methods of prevention are self-suggestive when one knows 
the life history of these worms. Meat thoroughly cooked and child- 
ren protected from infested cats and dogs would very soon solve the 
tapeworm problem. 



-NEMATODE WORMS. 



The term of Nematode, which means thread-like, is applied to the 
round worms. Those which are parasitic in the human body are 
either thread-like or spindle shape in form, varying in length from 
less than one millimeter to nearly or quite one meter in length. The 
outer surface of these worms is either smooth or covered more or 
less with hairs. Most of them are plainly segmented. The sexes are 
usually distinct, the male worm being much smaller than the female. 
The eggs pass from the body of the female before they are developed. 

Some parasitic worms pass through a well-marked larval stage, 
others undergo no particular change of form until they reach maturity. 
Some of them live independently of a host during a part of their lives, 
others spend their entire lives in the body of the host and in some cases 
two hosts are necessary for the complete development of the worm. 
Some parasitic worms are transferred from one animal to another by 
means of food or water, others are transferred only as the first host 
is devoured by the second one. 

Of the several round worms no one is more generally discussed 
at the present time than is the hook-worm. It is now known that this 
worm is so widely spread and its effects upon the human system are 
so disastrous, that we believe that we will be pardoned for going some- 
what extensively into its distribution and its life history. 

The hook-worm is an intestinal worm about one-half of an inch 
long and is usually found in the upper part of the small intestine to 

*Jour. A. O. A., Jan., 1914. 



NEMATODE WORMS 77 

the lining of which it attaches itself, and sucks the blood from 
neighboring capillaries. Aside from the injury which it does the 
patient by sucking his blood, it produces a distinct poison which is 
freely absorbed into the blood and this poison causes more or less of 
a disorganization of the blood corpuscles. 

The worm, which is about as large in diameter as an ordinary 
pin, varies in color from a whitish yellow to a dark brown or red, de- 
pendent upon the amount of blood it has drawn from its host. The 
male worm is somewhat shorter than the female and its tail is funnel 
form in shape, while the tail of the female is pointed. Otherwise, the 
sexes closely resemble each other. The worm has a strong tendency 
to flex its head upon its body and it is this peculiarity which gives it 
its name. 

The female lays from two to five thousand eggs daily after it 
reaches maturity. If these are deposited where conditions are favor- 
able the young worms hatch in from twenty-four to thirty-six hours. 
The most favorable conditions are realized when excreta rich in the 
eggs of these worms is deposited on moist and sandy ground. The 
young worms are nourished by the excreta and in about one week 
are ready to enter the foot or any other part of the human body which 
may come in contact with the ground. Under favorable conditions 
the hook worm may live for five or six months in the ground before 
entering the human body. The worms are usually introduced into the 
body by the patient either sitting on the ground or standing on the 
ground with bare feet. A local rash usually appears when the worms 
enter the flesh. After getting into the blood, they are carried over the 
body, usually leaving the blood in the lungs ; they then pass up through 
the air passages to the pharynx; from there they are swallowed and 
thus reach the intestine. It requires nearly three months for them to 
establish themselves in the intestine after they have entered the body. 
The local irritation caused by the entrance of the hook worm has been 
called by various names — ground-itch, dew-itch, dog-itch and cow- 
itch are some of the names which have been applied to this condition. 

The worms were first discovered by an Italian physician in 1843 
and it is only recently that they have been known to exist in this 
country. It is now known that they are widely distributed over the 
United States. Not only the inhabitants of the Southern States are 
known to be widely infected, but a number of cases have been reported 
in Utah, Nevada and California. 

The effect produced upon the victim of hook worm infection is 



78 PUBLIC SANITATION AND OTHER PAPERS 

most serious. The face usually presents a stupid appearance, the 
features are expressionless, the pupils of the eye are usually dilated, 
and inability to see at night is by no means uncommon. The chest 
is greatly flattened and the scapulae become prominent. Frequently 
the abdomen is swollen to a marked degree. The appetite is usually 
poor and more or less perverted. The "dirt-eaters" of the South are 
brought to this condition by hook worm infection. The depravity of 
appetite is frequently shown by the excessive use of tobacco and snuff. 
Girls are injured by hook worms more than boys and their develop- 
ment is frequently greatly delayed by these parasites. The red cor- 
puscles of the blood are frequently reduced to one and one-half mil- 
lions per cubic millimeter and the hemoglobin often falls below 30 
per cent, of what it should be. 

It is only necessary to know the life history of the hook worm 
to know how to prevent infection. All excreta which may contain the 
eggs of this worm must be carefully kept from the surface of the 
ground, and if one is obliged to be in regions where hook worms pre- 
vail, the feet should always be carefully protected by shoes and one 
should never sit upon the ground. In other words, with the hook 
worm danger, as with most other things relating to hygiene, cleanli- 
ness and continued cleanliness is the means of protection. The health 
authorities of the Southern States are carrying on an important cam- 
paign of education and undoubtedly much of the poverty of the South 
will be abolished with the abolition of this disease which so completely 
unfits its victims for profitable industry. 

The diagnosis of hook worm infection can only be made by 
microscopic examination of fecal matter. At the present time immi- 
grants are carefully examined before being admitted to this country, 
and if they are found to be the victims of this disease, they are treated 
before they are allowed to mingle extensively with other people. As 
before stated, the only real danger from hook worm infection is in 
those places where little or no attention is paid to the proper care and 
removal of sewage. 



HOOK WORM DISEASE 79 



*HOOK WORM DISEASE. 



This is one of the very old diseases which have affected humanity. 
It is said that a reasonably good description of the disease has been 
deciphered in an ancient Egyptian papyrus. It was described by some 
of the old Spanish physicians in Brazil as early as 1648, and at the 
time of our revolutionary war it was recognized as a dangerous dis- 
ease in tropical countries. It was not, however, until about 1850 that 
the disease was definitely associated with the hook worm, and it was 
not until 1893 that the disease was recognized in our country. The 
first case observed is said to have been in St. Louis. 

There are two closely related worms responsible for this disease. 
One is known a the Necator americanus, and the other as the Anky- 
lostoma duodenale. The specific name of the last species named is 
indicative of the part of the alimentary canal in which it is frequently 
found. The disease has received a number of different names : Egyp- 
tian chlorosis, Brickmaker's chlorosis, Tunnel anemia, Miner's anemia, 
being some of the more common names. It will be observed that all 
of these names associate this disease with the ground. We now know 
that the disease is very widespread and that its moral and physical 
effects are disastrous in the extreme. "The poor whites" in the South 
and the clay eaters of Georgia and Florida have long been objects 
partly of sympathy and partly of contempt. It is certain that their 
pitiable condition is due very largely to the parasites which they har- 
bor. The only positive diagnosis of this disease is made by finding 
the eggs of the worm in the excreta of the patient. 

Unlike the eggs of the whipworm (Trichocephalus trichiurus) or 
the eggs of the Ascaris lumbricoides, the eggs of the hook worm are 
not stained by bile but present a clear hyaline appearance. When these 
eggs are carelessly discharged upon the surface of the ground they 
hatch in from 24 to 48 hours. After hatching they pass through a 
series of changes requiring about four days, before they are ready to 
enter the body of the victim. At the end of about four days these 
changes are completed and whenever they have an opportunity to come 
in contact with the bare skin they quickly bore their way into the 
tissues. The result of this is an extreme irritation of the skin, pro- 
ducing what is known as the "ground itch" or dew itch. 

After the parasites have entered the body they quickly find their 

*Jour. A. O. A., Nov., 1910. 



80 PUBLIC SANITATION AND OTHER PAPERS 

way into the blood stream and when they are carried to the lungs they 
find their way into the air cells of the lung, from which they gradu- 
ally work their way into the throat through the trachea, and from here 
they are swallowed and soon reach their permanent home in the ali- 
mentary canal, beyond the stomach. 

From what has been said of the hook worm it is evident to us 
that the careful disposal of excrement from the body is the natural 
means of protection. If this matter receives proper attention, the 
spread of the disease becomes an absolute impossibility. 



*TREMATODA OR FLUKES. 



The scientific name of this group of parasites (Trematoda) means 
to bore a hole. The name is used to express the difference in character 
between these parasites and the Cestodes (Girdles), the latter living 
outside of the true body substance while the former inhabit some of 
the organs of the body. Consequently the name Trematoda is rather 
descriptive of their habits of life. 

Few parasites are more widely distributed than the Trematodas 
and very few have a more complicated and interesting life history. 
They are found in their mature state not only in a very wide range of 
mammals but they are also found in many birds and, in some cases at 
any rate, they inhabit the bodies of invertebrates. To illustrate their 
peculiar nature, it may be stated that one species has been found only 
in the frontal sinus of the skunk, while another species is only known 
to live in the nasal passages of the duck. It is, however, in some of 
the domestic mammals that the greater part of their disastrous work 
i c . done. It is only occasionally that they occur as human parasites, 
but when they do, the result is usually fatal. 

It is by no means unusual for parasites to pass their lives in the 
bodies of two animals. Among the many cases of this kind may be 
mentioned the Trypanosome, the various malarial parasites, all of the 
tapeworms and a number of the round worms, but the flukes add to 
this complicated existence one more intermediate host. That is, they 
live in three animals during their life cycle. From the fact that two 
intermediate hosts are common but not necessary to the life of the 



*Jour. A. O. A., March, 1914. 



TREMATODA OR FLUKES 81 

fluke, one may infer that the second host is a comparatively recent 
modification in the life of the fluke. 

As the life history of the sheep fluke has been carefully studied, 
I select this as a typical form to illustrate the complicated life history 
of the group. Let us start the history with the mature fluke living in 
the liver of the sheep. Eggs are laid in large numbers in the biliary 
passages and these find their way through the various bile channels 
into the intestine of the sheep. With the general debris of the in- 
testine these eggs are expelled from the body of the sheep. Should 
they fall upon the dry earth, they soon perish, but if by chance they 
drop into the water, they soon develop into a free swimming ciliated 
worm which after living for a short time in the water, enters the body 
of a snail. Here they reproduce themselves asexually and ultimately 
cause the death of the snail. If this occurs on the land, the young 
worms soon perish, but if the body of the dead snail falls into water, 
it quickly decomposes and the young worms are set free. After en- 
joying their freedom for a short time, they enter the body of another 
snail where they again asexually reproduce. This second snail is not 
as a general thing killed, but it crawls up on the stalks of weeds and 
herbage growing in the water and there glues itself to the stem of 
the plant. If by chance, this stem is eaten by a sheep and the snail 
swallowed, the parasites are set free in the stomach of the sheep after 
the snail is digested, and quickly passing through the stomach into 
the upper intestine, they make their way to the liver, there to begin 
the round of life again. 

It is practically certain that it is not absolutely necessary for the 
fluke to enter the body of its second host and that if the second host 
is not readily at hand, the free swimming worms at length attach 
themselves to herbage growing in the water and in this form may be 
directly taken into the stomach of the sheep and the life cycle may be 
completed in this way. It is also quite certain that if they should be 
inadvertently swallowed by a human drinking the water, the person 
may thus become infected with these most dangerous parasites. For 
that reason all water to which sheep have access should be regarded 
with great suspicion. 

The life of the fluke in the sheep has been divided into four pretty 
well defined periods. The first period is that of immigration or en- 
trance to the body. This often occurs in the autumn and it requires 
from four to thirteen weeks for the fluke to become ensconced in the 
sheep's liver. During this period the animal seems to suffer very 



82 PUBLIC SANITATION AND OTHER PAPERS 

little from its unwelcome guest and ordinarily no change is perceived 
in its health. This period of immigration is followed by a period of 
anemia. In Utah, sheep are in the anemic period more often in No- 
vember and December. If the animals have become fat by this time, 
the fattening is soon checked and the mucous membranes of the mouth 
and nose become pale or yellow. The sheep is sluggish in its habits 
and usually has a marked fever. The feces are normal in appearance 
but usually contain large numbers of the eggs of the fluke. The 
anemic period is followed by a period of wasting. This may occur 
during the month of January. The sheep becomes greatly emaciated, 
the mucous membrane is greatly blanched, the respiration is quick and 
labored and the appetite is very irregular. Abortion is very common 
among the females, and the face, legs, larynx, etc., become greatly 
edematous. Death is very frequent during this period. 

If the animal does not die, it passes on to the period of the emi- 
gration of the flukes. This may occur during May and June. For 
some unknown reason, the flukes frequently leave the liver at this 
time, pass into the alimentary canal and are voided from the body of 
the sheep. When this occurs the sheep makes a gradual, but never 
complete, recovery. The liver heals, but with the formation of a large 
amount of scar tissue. 

These periods are never so well marked in the human being as in 
the sheep, and yet one who is infected with the fluke worm may pass 
through all of these stages, recovery not being entirely unknown. 

Safety both of the human being and animals demands the one 
thing which seems to be the basis of all hygiene, and that is cleanliness. 
Water which is kept entirely free from the possibility of contamination 
can never become the means of bringing about the infection either of 
man or beast. 



A vast amount of the poor, illogical, morbid, extravagant, pessi- 
mistic, insipid thought that finds its way into books and sermons and 
conversation has its origin in poor bodies and bad health. The body 
lies at the basis of success in all respects. On the other hand, it is just 
as true that the mind controls the body. No person can be the victim 
of base and selfish conduct without his mind reacting unfavorably upon 
his physical condition; in other words, there seems to be a mutual 
action and reaction between body and mind. A sound body goes far 
toward making a sound mind; and a sound mind goes farther than 
many people realize toward making a healthy and vigorous body. 



POISON OAK 83 



*POISON OAK. 

At this time of the year it does not seem inappropriate to turn 
aside form the public health problems which are ever before us to one 
which concerns so many lovers of nature. 

Many people who are passionately fond of nature and who enjoy 
a ramble in the wild woods more than almost anything else, have their 
pleasure seriously curtailed by a constant fear of being poisoned by 
poison ivy, poison oak or poison sumach. Dr. Edward Van Adelberg, 
of Oakland, California, has made a somewhat careful investigation of 
these plants, and I have thought that I could not render a greater ser- 
vice to the readers of this department than to give them a resume of his 
investigations, together with some observations which I have personally 
made. 

These poisonous plants belong to the botanical order anacar- 
ciiaceae, and they are known to the botanists as follows : Poison oak 
is Rhus diversiloba : poison ivy. Rhus toxicodendron ; and the poison 
sumach, Rhus venenata. This group of plants is widely distributed 
throughout the United States. The poison ivy ranges from the Atlantic 
seaboard west to the Missouri River, and in some localities may be 
found even somewhat further west. It is not known to grow in the 
Pacific Coast States. In these states, poison oak seems to take its 
place. The plants closely resemble each other, and anyone but the 
technical botanist might easily mistake one for the other. The leaves 
of these plants are very beautiful, whether examined in the early Spring 
when they are beginning to grow, or in the late Fall when they are 
dying. The fruit is a berry, and like the blossoms and leaves, is rich 
in the poison afforded by the plant. The berries lose their poisonous 
properties when they ripen, so far as birds are concerned, for the birds 
eagerly eat them, and in this way aid in their distribution. 

The poison of these three plants seems to be identical. This was 
first determined by Dr. Pfaff of Harvard Medical School. Physicians 
have long recognized that dermatitis caused by the different plants 
is identical. 

Many attempts have been made to chemically isolate the poison 
from these plants. This work is particularly important because it is 
the necessary foundation of careful clinical study of the problems in- 
volved. So far as is known, a German student by the name of van 

*Jour. A. O. A., May. 1913. 



84 PUBLIC SANITATION AND OTHER PAPERS 

Mons first attacked this difficult problem in 1779. His conclusion was 
that the poison was some kind of a gaseous hydrocarbon which eman- 
ated from the plants only at night or on cloudy days. In 1825, Lavini 
again attacked the problem and concluded that the poison was a gas 
exhaled at night, but he thought it was not a hydrocarbon. In 1858, 
the problem was again attacked, and the chemist believed that the 
poison was due to "rhustannic acid." In 1865 it is recorded that another 
careful study was made and the conclusion was that toxicodendric acid 
was the offending agent. In 1882 and 1883, some Japanese chemists 
made a careful study of this poison, but their results were not satis- 
factory even to themselves, and it was not until Pfaff, in 1897, attacked 
the problem that the matter was made at all clear. Pfaff showed that 
toxicodendric acid is identical with acetic acid, and that the real toxin 
is really a non-volatile substance. This substance was named toxi- 
codendrol on account of its oily appearance. It was shown that 1/1,000 
of a milligram of this substance produces a very typical dermatitis. 
While all parts of the plant yield toxicodendrol, it is most abundant in 
the leaves and green berries. 

The careful work of Dr. Pfaff was supplemented in 1906 by Dr. 
W. A. Syme of Johns Hopkins University. Dr. Syme proved that the 
poison is glucosidal in character, and that it may be decomposed into 
gallic acid, fisetin and rhamnose. Dr. Syme showed that the poison is 
non-volatile even when mixed with acetic acid or with alcohol. A 
glance over this brief history shows that for a period of nearly 120 years 
the toxin was regarded as volatile, and that it is only during the last 
ten or fifteen years that it has been proved to be non-volatile. Several 
careful investigators have believed that the poison was due entirely 
to bacterial action. We now know that this is not the case, although 
it is highly probable that the dermatitis produced by the poison is often 
accompanied by bacterial infection. 

While it is now known that the toxic principal is non-volatile, the 
practical question arises as to how poisoning at a distance from the 
plant occurs. It is very certain that people may be poisoned without 
coming into direct contact with the plant. This is probably brought 
about by the poison being carried by pollen or plant hairs or dust, or 
people may brush against these plants unconsciously and thus get the 
poison on their clothing, and this is afterward transmitted to the skin. 
It has also long been known that the poison is readily transmitted by 
smoke. Experiments show that the temperature of boiling water is 
not sufficient to decompose the poison, and when the plant is burned, 



POISON OAK 85 

the poisonous principle is readily carried on particles of soot for con- 
siderable distances. There is a popular idea that the poison has a ten- 
dency to spread after it has been brought into contact with the body. 
Careful experimentation fails to confirm this view. The serum from 
the vesicle produced by the poison appears to be absolutely inert when 
it is rubbed upon other parts of the body. The so-called "spreading" 
of the poison is probably due to the fact that on those parts of the body 
where the skin is thinnest and most sensitive, the dermatitis first ap- 
pears, and where the skin is thicker, the poison penetrates more slowly, 
and hence appears at a later time. Nothing is accurately known as to 
the exact way in which the poisoning takes place. It has been believed 
by some that under certain circumstances, one may acquire immunity 
to poisoning by rhus, but experiments do not confirm this view. 

Many animals are very susceptible to the poison. Guinea pigs and 
rabbits usually die if a small amount of the poison is injected into their 
circulation. Dr. Von Adelung believes that the best means of pre- 
venting poisoning is to wash most thoroughly with soap and water 
after an exposure. He says : "I have frequently protected myself 
against poisoning, as have others, when not in direct contact with the 
plant, by simply washing the exposed surfaces within a few hours after 
exposure, using soap and hot water. When, however, I am to be 
thoroughly exposed, as in gathering the leaves or handling the dried 
plants, I prefer the protection of cotton-seed oil on hands, arms and 
face, gloves, a bath for the whole body as soon after exposure as possi- 
ble, and a change of clothing." 

If one has been exposed to this poison, he should change every 
article of clothing as soon as possible and use the bath, as already sug- 
gested. Clothing which may have come into contact with this plant 
should not be worn until it has been washed, or if it cannot be washed, 
it should be sent to the steam cleaner. Experiments show that the 
dermatitis may be greatly relieved by the use of hot water, ichthyol 
collodion, potassium permanganate, magnesium sulphate and tincture 
of iodin. 

Every lover of nature should be enough of a botanist to readily 
recognize these plants, and when they are recognized, one need be 
in little danger from them if he observes the precautions which have 
been mentioned. 



86 PUBLIC SANITATION AND OTHER PAPERS 



*INFANTILE PARALYSIS. 

This disease was first clearly described in 1840. Previous to that 
time it was confused with a number of other somewhat similar dis- 
eases. It is known to occur in a good many different forms and these 
different forms are largely determined by the part of the nervous sys- 
tem which is affected. When the disease attacks the bulbar region, it 
usually runs a very short course and the patient quickly dies. 

The mortality ordinarily ranges from 5 to 20 per cent of those at- 
tacked, and of those who escape with their lives, 75 per cent are crip- 
pled to a greater or less degree. 

The greater number of victims of this disease are children be- 
tween the ages of one and five years, and it is somewhat more common 
in summer than in winter. The incubation period is believed to range 
between two and thirty days, and it is believed that the organism pro- 
ducing the disease is especially abundant in nasal and mucous secre- 
tions. 

The early symptoms of infantile paralysis so closely resemble the 
early symptoms of other diseases that careful diagnosticians are agreed 
that it is not safe to recognize the case as infantile paralysis until the 
paralysis has actually manifested itself. Unfortunately, this precau- 
tion is not observed by the ordinary practitioner, and because of this, 
many cases of intestinal and other diseases are undoubtedly called in- 
fantile paralysis. It is unfortunate that snap judgments should thus be 
passed, as it leads to terrorizing the community, and especially the 
family of the victim. 

It is impossible too strongly to urge physicians to withhold ex- 
pression of opinions until there is reason to believe that the opinion is 
well founded. No matter what the disease may be, the physician may 
observe all precaution necessary in the most serious cases without 
causing any undue alarm to relatives. If a serious disease then mani- 
fests itself, there is still plenty of time to prepare the family for the 
burden which they will have to bear. 



r West. Ost., Aug., 1912. 



MEASLES AND AFTERMATH 87 



*MEASLES AND AFTERMATH. 

Few people appreciate the real seriousness of an epidemic of 
measles. The disease is regarded by many as an incident in the life 
of a child, and as a more or less serious joke if the victim is a grown 
person. This view is not held by those who are at all familiar with the 
real nature of the disease. 

In and of itself, measles is not, in a large majority of cases, any- 
thing particularly serious, but the after effects are far-reaching and 
these, together with the primary disease, are so serious that students 
oi the history of medicine rank measles third among infectious diseases 
for causing death. 

It is well known to all students of hygiene that any person whose 
vitality is impaired is much more susceptible to an infectious disease 
than is a person in robust health. The impairment of the health by 
some diseases especially lowers the resistance of the body to other 
diseases. Of the diseases which lower the resistance of the body, mea- 
sles probably ranks well toward the first. Either the child or the adult 
who has had measles is especially liable to contract lung disease. 

If he takes cold during the time that he has measles or soon after 
the rash has disappeared, he stands in special danger of pneumonia, 
and pneumonia following measles is more dangerous than uncompli- 
cated pneumonia. If he escapes pneumonia there is a considerable 
length of time during which he is particularly susceptible to tubercular 
infection. This infection is so often insidious and its evidences are so 
obscure that by the time the disease has fully developed one may almost 
have forgotten the mild attack of measles which really paved the way 
for this extremely serious malady. 

If one escapes all lung diseases, there is danger that the eyes may 
seriously suffer. About the only way to protect the eyes after an at- 
tack of measles is carefully to avoid strong light and, for some weeks, 
at any rate, resolutely to refuse to fatigue the eyes by any kind of close 
work. I know that this may mean that some children will "fail to 
make their grades," but it is far better that a child should fail to make 
several grades than that he should suffer all of his life from an un- 
necessary impairment of his eyesight. 

It is most earnestly hoped by all friends of our young people who 
have been and who are the victims of measles that every care will be 

*So. Pas. Rec, Mar., 1910. 



88 PUBLIC SANITATION AND OTHER PAPERS 

taken to avoid the serious after-effects which are so frequently experi- 
enced. Intelligent and persistent care between now and the close of 
our schools in June will not only save thousands of dollars in future 
doctors' bills, but it will greatly diminish the death rate during the 
next rive years and will add immeasurably to the efficiency of the gene- 
rations upon whose shoulders the burden of society will so soon fall. 



*MEASLES. 

As this disease is widely spread in our city at the present time, a 
few words in regard to its history and nature may not be out of place 
in this connection. 

For a long time, measles, scarlet fever and small pox were confused 
with each other. In 1676 a French physician undertook to differentiate 
scarlet fever from the other two diseases, but it was not until almost 
the beginning of the last century that small pox and measles were clearly 
differentiated from each other. The measles appears to have been 
brought to this country by the early settlers of New England, and it 
proved singularly fatal to the Indians of that region. 

The white man's diseases seem to have been quite as fatal to the 
New England Indians as were his bullets. Measles did not reach Cal- 
ifornia until 1846. Since then it has spread to all parts of the state. 

Uncomplicated measles presents few dangers to the patient, but 
there is great danger of pneumonia following an attack of measles, and 
the diseases which immediately follow measles rank third in causing 
death in the United States. Not only are these diseases to be avoided, 
but it must be remembered that the eyes are usually left in a much 
weakened condition following measles, and great care must be taken 
to save them from serious injury. It often happens that children are 
kept in very badly ventilated rooms in the effort to keep them from 
strong light. It is much better to protect the eyes by dark colored 
glasses and then allow plenty of sunshine and fresh air in the sick room. 

Few diseases are more contagious than measles, and great care 
should be exercised to keep those who are in a low state of vitality 
from contracting the disease. 



b So. Pas. Rec, June, 1913. 



PELLAGRA 89 



PELLAGRA. 



Pellagra, so far as the name is concerned, is a new disease in the 
United States. It is by no means improbable that it has existed here 
for a long time, but until recently no positive diagnosis of the disease 
had been made. 

It is pre-eminently a disease of Southern France, considerable parts 
of Italy, Switzerland, and the land through which the Danube flows. 

The symptoms of pellagra in its early stages are exceedingly vague. 
The patient may suffer more or less from headache, insomnia, and illy 
defined digestive troubles. At a later time the skin becomes rough, 
presenting many of the appearances of eczema. Occasionally pus forms 
under the hard rough scales of the skin. If the disease progresses to- 
ward its most serious stages, the patient has marked mental troubles, 
sometimes a well-developed suicidal mania, and he may suffer from 
severe spasms and partial paralysis. 

A disease whose results are serious as are those of pellagra is one 
which should be most carefully studied and one from which we should 
protect ourselves by every known method of prophylaxis. All intelli- 
gent prophylaxis must, of course, be based upon a knowledge of the 
disease, and at the present time our knowledge of the disease is very 
slight. 

Those who have studied pellagra most carefully are divided in 
opinion as to whether it is a constitutional disease or a disease due to 
an infection. Those who incline to regard it as a disease due to infec- 
tion are divided in opinion as to whether the infection is bacterial or 
protozoan. Almost all careful students of the disease are of the opinion 
that it is due in some way to the use of a low grade of Indian corn. The 
only marked exception to this view is to be found among French physi- 
cians. 

In controversial literature upon this subject, those who hold that 
there is a close connection between Pellagra and spoiled corn are known 
as Zeists; those who hold the opposite views, viz., that corn is not in 
any way connected with the disease, are known as Anti-Zeists (the term 
Zeist is derived from the scientific name of corn — Zea maize) ; those who 
hold that the disease is due to corn are again divided among themselves 
in opinion, some holding that the corn has undergone some vital change 
which makes it a poison. Those who hold this view, point to the well- 

*West. Ost., Jan., 1910. 



90 PUBLIC SANITATION AND OTHER PAPERS 

known fact that if the potato grows partially exposed to the sun, a 
distinct poison develops in it. Others hold that where corn is used ex- 
tensively as a food, the process of digestion leads to the formation of 
poisonous products producing one form of auto-intoxication. Another 
group of the Zeists hold that poison may have been developed in the 
corn by either bacterial action, the growth of molds, or the develop- 
ment of some protozoan animal. It certainly seems that in some way 
the disease is not only connected with corn, but, as before stated, with 
corn which has undergone some kind of decomposition. 

It is, of course, possible that we shall eventually find that the rela- 
tionship between Pellagra and corn is in some respects like the relation- 
ship between malaria and mosquitoes. 

The question continually arises as to whether or not Pellagra is 
a communicable disease. The best authorities believe that Pellagra is 
not transmitted directly from one person to another. In this respect 
ib it quite comparable with malaria. 

Roussell, a French physician who has made a most careful study 
of Pellagra, says: "Although the hypothesis of a pellagras virus has 
had a place in the discussions of the last century, and has even appeared 
in divers authorities of our own time, it has seemed to me useless to 
try to refute it. It can be said of the contagion of Pellagra that it is a 
question fully determined. . . . Pellagra is not contagious." 

Procopiu says : "The disease is not contagious, and the sick may 
associate intimately and freely with the well ; and if spoiled maize is 
not eaten, the disease does not occur." 

Mr. Cutter, who is not a physician, but was a most careful student 
of the disease in Italy, says : "Pellagra is neither infectious nor conta- 
gious. It is transmissible like insanity in the form of a previous dis- 
position." 

It is needless to say that these views may be somewhat modified 
by further study. 

The first national conference on Pellagra held in the United States 
convened at Columbia, South Carolina, on November 3d and 4th, 1909. 
There were 350 delegates, representing most of the eastern and south- 
ern states. The papers presented at this conference were of far-reach- 
ing interest and importance, and it has stimulated such interest in the 
subject that we may expect our knowledge of Pellagra to be vastly 
increased in the immediate future. 



HYDROPHOBIA 91 



^HYDROPHOBIA. 

Few diseases bring more terror to the ordinary individual than 
hydrophobia. Part of this is due to the really serious nature of the 
disease and a part to the mystery which surrounds it. 

It is a disease which is very rarely transmitted from one person to 
another, but is almost invariably acquired from the bite of some animal 
suffering from the disease. Statistics indicate that the disease is more 
frequently contracted from the cat than from any other animal. The 
number of cases, however, contracted from dogs very nearly approaches 
the number contracted from the former animal. 

The disease is apparently of world-wide distribution. It is very 
common in Russia, rare in northern Germany, common in southern 
Germany and France and, at the present time, almost unknown in 
England. In many parts of the United States it is unfortunately com- 
paratively common. In all of the countries where it is common little 
or no attention is paid to the health or habits of domestic animals. In 
England where the disease is practically unknown, domestic animals 
receive the most careful attention and dogs running at large are always 
muzzled so that they may not endanger other dogs or human beings 
with whom they come in contact. 

When a person or animal is bitten by a dog or cat suffering from 
the disease it is by no means certain that he will become infected. 
Statistics indicate that only about 15 per cent of the persons bitten by 
rabid dogs contract the disease. When the bite is on the face or hands 
or some exposed portion of the body infection is much more likely to 
occur than when the person is bitten through clothing. 

When a person is infected a considerable period of time, varying 
from two weeks to as many months, will elapse before any symptoms of 
the disease manifest themselves. The time elapsing between the time 
of infection and the appearance of the disease is known as the incuba- 
tion period. In young people the incubation period is somewhat shorter 
than for older people. 

It is observed that punctured wounds, such as might result from 
the snap of a dog, are more dangerous than lacerated wounds. When 
a person contracts the disease the first symptoms usually manifest them- 
selves in the form of mental depression, sleeplessness, irritable temper 
and headache. This stage is quickly followed by a highly excitable 

*So. Pas. Record, Dec, 1909. 



92 PUBLIC SANITATION AND OTHER PAPERS 

condition of the nervous system. In this stage a bright light or sudden 
noise may throw the person into convulsions. The same is true when 
one attempts to swallow water ; hence the popular name of the disease, 
which really means "afraid of water." The state of excitement and irri- 
tability is followed by a state of extreme depression and paralysis and it 
is in this state that the victim usually dies. 

It is a matter of great importance to know that there is a not un- 
common disease known as pseudo, or false hydrophobia, which is a 
hysterical condition closely simulating the real disease. It will be noted 
that the premonitory symptoms of hydrophobia — depression, sleepless- 
ness, headache, irritability — are conditions which not infrequently follow 
even mild dissipation, and a person who is conscious of having been 
bitten by a dog or cat and who has these symptoms from a totally differ- 
ent cause, is in danger of allowing his fears to so prey upon his mind 
that he will force himself through the several stages of hydrophobia, 
even up to the point of actually dying. Surely these are conditions 
where the experience of Job is repeated — "The evil which I feared hath 
come upon me." 

There is a popular idea that people suffering from hydrophobia 
have a tendency to bark and snap at those around them ; in short, that 
they display the symptoms of a dog suffering from the disease. This 
belief is entirely without foundation. The belief is, however, so deeply 
grounded in the popular mind that the person suffering from hysterical 
hydrophobia goes through the various actions of a dog because he 
supposes that he absolutely has to do so. This is at least one means by 
which the intelligent and careful physician may be able to distinguish 
between the true and the false forms of hydrophobia. 

There seems to be no doubt of our having infected dogs among 
us and the only rational thing to do is to immediately protect ourselves 
from them. Every dog, for the safety of the people at large as well as 
for the safety of his fellow dogs, should be at once muzzled. This does 
not necessitate any inhumanity, nor even any serious inconvenience to 
the dog. But if this is done, it will positively and unquestionably pro- 
tect us from a real danger by which we are menaced. It is needless 
to say that when this is done we should, so far as possible, cease dis- 
cussing our danger and use all intelligent means to remove needless 
fears from children and hysterical people in general. In an intelligent 
community no one should be exposed to unnecessary danger, nor should 
people allow themselves to impair their own usefulness or the useful- 
ness of others by yielding to unnecessary fear. 



HYDROPHOBIA 93 



^HYDROPHOBIA. 

The dog which was shot last week did not have hydrophobia, as 
was generally supposed. I secured the head of the dog the same even- 
ing that it was shot and spent the greater part of the next day making 
a careful examination of its brain. I was unable to find any evidence 
whatever that the dog was affected with rabies, or as it is popularly 
termed, hydrophobia. 

As we frequently read of examinations of this kind being made, it 
has occurred to me that a brief explanation of how an examination of 
this character is made might not be without interest to our people. 
Rabies is a disease caused by an animal parasite which lives in the brain 
cells of the afflicted person or animal. This parasite is of course micro- 
scopical in size and is itself a minute animal instead of being a minute 
plant. Minute vegetable forms which cause disease are known as mi- 
crobes ; minute animal forms which cause disease belong to a group of 
animals known as the protozoa. Most of the disease-producing microbes 
and protozoans are carried over the body of the patient in the blood, but 
a few of them, and the organism producing hydrophobia is one of these, 
reach their final destination in the nerve cell by traveling over the nerve 
fibers. This explains why it is that the person or animal infected by 
hydrophobia requires so long a time to give positive evidence of having 
the disease. The time elapsing between an infection and a manifestation 
of the disease is known as the latent period. During the latent period of 
hydrophobia the animal organism causing the disease is slowly moving 
up the nerves of the part of the body bitten towards the nerve cells of 
the spinal cord and the brain, and it is not until they reach the nerve 
cells of these organs that the disease manifests itself. 

These organisms cannot be seen under ordinary circumstances in 
the nerve cell. In order that they may be seen it is necessary to crush 
the nerve substance and smear it over a piece of glass. After the smear 
becomes perfectly dry it is first acted upon by a solution of picric acid 
in wood alcohol. After being acted upon by this for three or four 
minutes the solution is poured off and the slide is again dried under a 
blotting paper and the smear is then stained with two coal tar products 
which are known as Fuchsin and Methylene Blue. After being ex- 
posed for two or three minutes to this stain the stain is washed off and 
the specimen is then examined under the high power of the microscope. 

*So. Pas. Rec, Sept., 1910. 



94 PUBLIC SANITATION AND OTHER PAPERS 

If the animal has hydrophobia there is always a possibility of finding 
the microscopic organism inside of the nerve cells thus prepared. If 
they are found the organisms will appear as bright red dots in the bluely 
stained nerve cell. It is perhaps needless to say that considerable experi- 
ence in this line of work is necessary to make one's observations of any 
particular value. 

In the case of this particular dog, I prepared eighteen separate slides 
and probably examined no less than from 125 to 150 separate nerve cells. 
In none of these did I find the Negri bodies ; as these parasites are 
called. It is only proper to say that a failure to find the Negri bodies 
does not by any means prove that the dog has not hydrophobia, but it 
is strong presumptive evidence that he has not, and the greater the num- 
ber of nerve cells studied without finding them, the greater is the pre- 
sumption that the dog is not affected. 

Although hydrophobia has been recognized as a disease for nearly 
twenty-five hundred years, there are still many intelligent people who do 
not believe that any such disease exists. One reason for this skepticism 
is undoubtedly based upon the fact that there is a peculiar mental condi- 
tion known as pseudo-hydrophobia in which the victim has many of the 
symptoms of the disease without having the disease at all. Pseudo- 
hydrophobia is undoubtedly one form of hysteria and comes from an ab- 
normal fear of the disease. While there is no doubt that such a disease 
as hydrophobia exists, and while it is not easy to over-estimate the 
horrors of the disease, the fact still remains that a comparatively small 
number of people suffer from it even if they are bitten by a dog that 
is unquestionably affected by it. There are probably several reasons for 
this, one being that if the dog bites through clothing these organisms 
which may be in the saliva of the dog are quite likely to be wiped off 
on the clothing. Another is that if the wound made by the dog bleeds 
freely the organisms are likely to be washed out by the blood. Another 
is that even if the organisms are left in the tissue of the victim's body, 
they may not come in contact with nerve endings and so they have no 
road over which they may travel to the spinal cord or brain. 

Good judgment on the part of the people of a community is mani- 
fested in first reducing the number of dogs to a minimum. Before any 
person in a modern city possesses himself of a dog he should fully satisfy 
himself of his need for the animal ; next, as soon as a dog shows any 
symptoms of disease, he should be confined until he is fully recovered. 
Having taken all of the precautions which can be taken, people should 
never permit themselves to become the victims of fear. If one is bitten 



HYDROPHOBIA 95 

by a suspicious dog he should secure free bleeding from the wound as 
quickly as possible. He should consult with those who know the most 
in regard to such further treatment as may be necessary ; then he should 
interest himself in his business and dismiss all fear from his mind. If 
this does not protect him from hydrophobia it will at least protect him 
from the false form of the disease. 



-HYDROPHOBIA. 



Los Angeles is having something of a flurry of rabies, or hydro- 
phobia. Two or three deaths have recently occurred in the city, said 
to be due to this disease. The fact that such a disease exists has been 
questioned by some writers, but we believe its existence is as well estab- 
lished as anything can be. It does not necessarily follow that every 
dog that is sick or that is out of sorts or cross is the victim of hydro- 
phobia, but ordinary precaution indicates that a dog of that kind shall 
not be permitted to run at large, and that he shall be most closely 
watched until his condition can be definitely ascertained. 

Different as are the symptoms of rabies and tetanus, it is neverthe- 
less true that some physicians who should have known better have mis- 
taken one for the other. Every physician in the state should be keenly 
alive to the importance of an early recognition of these somewhat rare 
diseases, and everyone should inform himself of the proper thing to 
do should one of these cases come under his treatment. 

A dog suspected of this disease should never be immediately 
killed, but he should be securely confined and closely watched. If he 
recovers all thoughts of hydrophobia may be dismissed ; if, on the other 
hand, he dies, and especially if he exhibits severe nervous symptoms, 
his brain should be immediately submitted to a competent pathologist 
for examination. Unless there is reason for doing otherwise, the best 
thing to do is to send the dog's head packed in ice, to the director of 
the State Hygienic Laboratory at Berkeley. No physician in this age 
can offer any valid excuse to the public for failing to take necessary- 
precautions with this dreadful malady. 



'West. Ost., Sept., 1911. 



96 PUBLIC SANITATION AND OTHER PAPERS 



*TYPHOID FEVER. 

As we are entering upon that season of the year when cases of 
typhoid fever are most likely to occur, a few words on the subject may 
not be out of place. 

Like diphtheria, typhoid fever results from infection by a special 
microscopical organism. The organism which produces typhoid fever 
is the bacillus typhosus, and it is almost invariably introduced into the 
body with either food or drink. In a majority of cases typhoid fever 
is acquired from water in which the bacillus is living. Any water which 
is contaminated by excrement of any kind is liable to carry this in- 
fection. While poor ventilation and many kinds of filth will not cause 
typhoid fever, they may, by lowering the general vitality of the patient, 
make him much more susceptible to the disease. A noted physician has 
called our attention to the frequency with which the disease is spread 
by "fingers, food, and flies." Fingers, because they may become con- 
taminated from the secretions and excretions of the patient's body, 
flies, because they quickly visit excretions which may be rich in bacilli, 
and food because the flies with bacilli hanging to them, crawl over the 
food, leaving the bacilli in their wake. The bacillus typhosus lives in 
water for an indefinite length of time, sometimes for weeks. If 
water containing these bacilli is frozen to ice they are not destroyed, 
and when the ice is used the water from it is a source of danger. 
Raw vegetables are also dangerous when they have been irri- 
gated by water containing the bacilli. For this reason it is exceed- 
ingly dangerous to use raw vegetables which have been raised by 
sewage irrigation. 

All cases of fever at this time of the year should receive careful 
attention, and it is well to remember that it is no easy matter for the 
most competent physician to recognize typhoid in its early stages. 
During the progress of the disease the utmost care should be taken to 
disinfect everything which comes in immediate contact with the patient. 
All excretions from the body should be carefully guarded from flies 
and immediately disinfected, and after the patient's recovery ordinary 
prudence requires that the room in which the patient has been, be 
thoroughly disinfected. 



*So. Pasadenan, Nov., 1907. 



TUBERCULOSIS 97 



♦TUBERCULOSIS. 

The almost world-wide movement looking to the stamping out 
of tuberculosis is increasing in general interest rather than decreas- 
ing. Reports of consuls from all foreign countries indicate that 
vigorous steps are being taken for its suppression. These three state- 
ments are being kept clearly before the people of all civilized countries : 
"Tuberculosis is a preventable disease." "Tuberculosis is a curable 
disease." "Tuberculosis is a contagious disease." 

So much has been said in regard to all of these propositions 
that it really seems there is little left to say which is new, but the 
relationship between tobacco and tuberculosis has not, so far as 1 
know, been discussed. I was led to think along this line last summer 
and as a means of information I made bacteriological examinations 
of sputum collected from the cuspidors of hotels. In several of these 
specimens I found the bacilli of tuberculosis. As a considerable 
amount of the material intended for the cuspidor frequently goes onto 
the floor or drops over the side of the unclean utensil, it is easy to see 
the danger of infection from this source. 

The almost universal demand for the cuspidor is based upon the 
almost universal habit among men of using tobacco. I know that 
one treads upon rather dangerous ground when he ventures to condemn 
a habit that is so universal. I know that it is a great deal safer for 
the average minister to preach against the sin of worshiping idols in 
Burmah than it is to condemn the use of California wine. But some- 
times there is no harm in raising one's voice against an evil even if 
that evil is wide-spread and is close at home. 

When one has said all that he can justly say about the evil effects 
of tobacco upon the individual he has not pointed out one of the most 
serious evils from its use, and that is that it is at least indirectly the 
means of spreading tuberculosis. If we should do away with the use 
of tobacco we would do away with the only excuse for expectoration 
in public. Might it not be well for the physician who is bound by the 
most sacred obligations to care for public health to give this matter a 
little serious consideration? In a very low, mild and tremulous voice 
I would like to inquire if this is not specially worthy of the attention 
of that special branch of physicians who are justly and conscientiously 
filled with fear and horror of the evil effects of drugs ? 

Much of the fear of tuberculosis in the popular mind is without 

*West. Ost., Sept., 1910. 



98 PUBLIC SANITATION AND OTHER PAPERS 

rational foundation. No one should underestimate the danger of a 
tubercular person living in a house, but on the other hand it is very 
certain that a house in which a tubercular patient has lived, or died 
for that matter, may be made perfectly safe by proper fumigation. 

The best method of fumigation that I know of is the formalin 
one. Take from one and one-half to two pounds of formalin for each 
one thousand feet of space. Place this in a large tub and when the 
doors and windows of the room or house are properly closed, add 
about seven ounces of potassium permanganate to each pound of form- 
alin. This will produce a rapid liberation of formaldehyde gas. The 
room or house should remain unopened for from twelve to twenty- 
four hours, the latter length of time being preferable. I find it better 
not to closely cork the windows as by doing this the window cracks 
are protected from the effects of the formaldehyde gas, and when 
the quantity of formalin is used which I have suggested enough re- 
mains in an ordinary tight room to secure its thorough disinfection and 
that which escapes round the window disinfects the window cracks. 

A physician should not only make a general study of this disease, 
but he should make a careful individual study of every patient so that 
he may advise him in such a way as to secure not only his own restor- 
ation to health when that is possible, but also so that he may not be 
a source of danger to those with whom he comes in contact. 



*TUBERCULOSIS. 



We herewith present a few important facts relating to tubercu- 
losis which cannot be too widely known: 

1. Tuberculosis can be prevented. 

2. Tuberculosis can be cured. 

3. Tuberculosis is communicable. 

4. Tuberculosis is not inherited. 

To fully protect others the patient should: 

1. Burn all his sputum. 

2. Use separate eating utensils. 

3. Never allow another to use his napkin. 

4. Sleep alone. 

5. Keep his face and hands clean. 

6. Use long sheets for his bed and have them washed frequently. 

*Printed for Health Office use; also in So. Pas. Rec, Jan., 1914. 



ONE-FOOT SKATING 99 

To fully protect himself the patient should: 

1. Never swallow his own sputum. 

2. Never use a handkerchief to wipe sputum. 

3. Sleep as nearly outdoors as possible. 

4. Work only in the open air. 

5. Eat the most nourishing food. 

6. Rest when weary. 

7. Avoid all alcoholic drinks and tobacco. 

8. Keep out of all dust. 

9. Remember that patent medicines are of little or no value and 
are frequently injurious. 

10. Consult the best physician you can, and conscientiously fol- 
low his advice. 

11. Wear no mustache or beard, especially around the mouth. 



*ONE-FOOT SKATING. 



In the Record of October twenty-second a very timely article on 
one-foot skating was printed. I believe that all of the dangers pointed 
out in that article exist, but there is perhaps one more serious than 
those mentioned, and that is the danger of seriously deforming the 
pelvis and interfering with its normal relationship to the spinal col- 
umn. No physiological truth seems more certain than the one that 
normal structure is necessary to health. One need not possess much 
knowledge of the body to realize that when the whole weight comes 
upon one foot when the body is curved as it is to secure an equilibrium 
while skating, the result must be a more or less serious deformity of 
young and growing boys. Rheumatism and serious disorders of 
the nervous system are very likely to follow this practice. The evil 
results may not be immediately felt, but they will come none the less 
certainly. We have no duty more important than that of furnishing 
good normal and consequently valuable citizens to the next genera- 
tion. This duty is partially met by our earnest efforts to aid the young 
in reaching adult life in a high state of physical efficiency. 



*So. Pas. Rec, Nov., 1908. 



100 PUBLIC SANITATION AND OTHER PAPERS 



*BUBONIC PLAGUE. 

The Bubonic plague, as is generally known, is a highly conta- 
gious disease, due to infection by a specific bacillus. The bacillus is 
commonly introduced into the body through the skin. This intro- 
duction may be through even a microscopical abrasion of the skin, or 
it may be introduced by the bites of flies, fleas, and possibly other 
insects. The bacillus may also be introduced into the body with either 
food or drink. Rats, mice and ground squirrels are especially liable 
to the disease, and in these animals the disease may become chronic, 
that is, the animal may live for a long period of time, after contracting 
the disease, and be able to transmit the disease to other animals or to 
persons. It is believed that the disease may be spread either by flies or 
fleas as both of these insects may be found upon rats which suffer from 
the affliction, and both are known to be subject to the disease. Since 
rats and mice are so especially subject to the disease and since they 
come in such close contact with people it is especially desirable at this 
time that they be as thoroughly and completely destroyed as possible. 
The best way to destroy both rats and mice is to destroy the places 
where they live, and the best means of accomplishing this end is to 
clean up filth every where it may be found. 

I am satisfied that one of our most prolific sources of rats is to be 
found in our garbage holes. In these there is almost inexhaustable 
amount of food for both rats and mice, and as long as we furnish such 
an abundant food supply extermination will be by no means easy. Our 
danger from Bubonic plague is very slight, but a slight danger does 
exist. Any person who visits a seaport town may contract the dis- 
ease, and if the nature of the disease is not immediately recognized 
this would easily be transmitted to rats and mice in the house and from 
these the disease might be transmitted to other rats and mice and in 
this way the plague might spread in a town as seemingly remote from 
danger as South Pasadena. 

Dr. Foster urged very strongly upon the health officers the de- 
sirability of encouraging a campaign against rats and mice in every 
place. It is evidently the intention of the State Board to prevent the 
introduction of the plague into Southern California, and it is need- 
less to say that we who live in this part of the State sympathize with 
the State Board in their anxiety on our behalf. Aside from the war 

*So. Pasadenan, Dec, 1907. 



BUBONIC PLAGUE 101 

of destruction which he urged upon the rats and mice, Dr. Foster ad- 
vised that every means known should be taken to destroy flies. 

It may not be out of place to say that while cats should be en- 
couraged at this time because of their destruction of mice, they should, 
however, be kept at a distance from children, as cats are occasionally 
afflicted with the plague. The State Board directs that the local health 
officer, by personal examination of each dead body, satisfy himself as 
to whether or not the person could have died from Bubonic plague, 
and the Board also directs that a post mortem examination be held 
upon the body of every person who dies suddenly from pneumonia, 
typhoid fever, uremia, or any other disease whose outset was quickly 
followed by fatal termination. 



-BUBONIC PLAGUE. 



We read with deep sorrow the awful suffering which the Bubonic 
plague is inflicting upon the inhabitants of Manchuria. According 
lo statements which we regard as perfectly trustworthy, thousands of 
people are dying every day, and hundreds of thousands are starving 
and must continue to starve until the next harvest. 

Most of the civilized races of the world are beginning to bestir 
themselves in behalf of these unfortunate people. We are glad to 
know that the United States is likely to do its full share in the good 
work. 

The present epidemic began in 1894, some seventeen years ago. 
At that time it was most violent in some of the western provinces of 
China and India. It is estimated that no less than 6,000,000 people 
lost their lives in the latter country. 

It appears to be a perfectly well-established fact that the Bubonic 
plague is primarily a disease of rodent animals, and that it spreads 
tu the human being through the agency of fleas and perhaps other 
parasitic insects. Understanding its nature as we do, there seems 
little reason why it should ever gain a serious foothold in our coun- 
try, but eternal vigilance is the price of safety. It is certainly regret- 
table that a small school of political physicians should undertake to 
use common scientific information as a means of advancing their own 
selfish ends. The nature of the Bubonic plague and the means of con- 
trolling it are scientific questions, and this scientific information is the 
property of the world, not of any one system of therapy. 

*West. Ost., March, 1911. 



102 PUBLIC SANITATION AND OTHER PAPERS 



*BUBONIC PLAGUE. 

If the average American could see himself as he is seen by others, 
he would either laugh or cry. One of the things which would excite 
either his mirth or his grief is the spasmodic way in which he devotes 
his attention to the things which excite his interest. Some of us re- 
member that when Admiral Dewey was returning to this country 
after the battle of Manila Bay, almost the only question which occu- 
pied our thought was what on earth we could do to show our gratitude 
to the Admiral. For a few weeks nothing on earth which he could 
have wanted would have been denied him, but very soon after he got 
home our attention was turned in some other direction, and the 
Admiral received scant attention. 

We in California have acted in somewhat the same way in regard 
to the Bubonic plague. Fifteen months ago it was an easy matter to 
go before any city council and secure an appropriation which made it 
possible to fight and exterminate rats and squirrels. During the past 
six months few or no cases of Bubonic plague have been reported, and 
we have sunk into a condition of almost complete apathy. While it 
is possible that at one time we were too much excited, it is very cer- 
tain that we now give the matter too little consideration. 

Aside from the danger of spreading the plague, the rats and 
squirrels of the United States levy upon us a tax that is absolutely 
appalling. Careful statistics, extending over several years of time, 
show that in the cities of over one hundred thousand inhabitants in 
the United States, there is a direct loss of at least $20,000,000 a year 
due to rats. It is probable that twice this sum would be required to 
represent the loss inflicted by rats and squirrels in the smaller towns 
and in the country in general. Even if rats presented no menace to 
public health, the loss they inflict is so great that we should never rest 
until they are exterminated. It is not at all improbable that the in- 
direct loss caused by rats through the fires they originate, wood work 
which they destroy, etc., is equal, and perhaps more than equal, to the 
direct loss occasioned by them. 

There seems to be no reasonable doubt that rats and squirrels 
perpetuate Bubonic plague more than all other causes combined. It 
is now quite certain that Bubonic plague is seldom if ever transmitted 
directly from one person to another. When several persons in the 

*West. Ost., Nov., 1909. 



BUBONIC PLAGUE 103 

same house are afflicted with the plague, it simply means that they 
have contracted it from the same source. 

Rats and squirrels are particularly subject to this disease, and they 
may have it in either the acute or the chronic form. When they have 
it in the acute form they quickly perish, but when they have it in the 
chronic form they may live for weeks and even months, but wherever 
they go the pus which may drop from abscesses is a means of spread- 
ing the disease. Probably in the great majority of cases the disease 
is communicated to human beings by means of fleas which live on 
the rats, and which become infected from them. While these fleas do 
not permanently live on human beings, it is known that they may tem- 
porarily take up their abode in our clothing and on our bodies. The 
family cat may occasionally be the means of communication between 
the rat and the person. 

Filth, bad drainage, poor ventilation, unsanitary conditions gen- 
erally, need unsparing condemnation, but these things are never the 
means of originating plague, only as all of these conditions are favor- 
able for the presence and further increase of rats. 

Unless one has made a special study of the matter he is not likely 
to clearly estimate the rapidity with which rats reproduce themselves. 
Under favorable conditions from six to eight litters may be born dur- 
ing each year and the number of young range from two or three to a 
dozen. Under conditions favorable to them, rats begin to breed when 
not more than three months old. These facts plainly indicate the im- 
portance which should be attached to killing every rat which one can. 
Owing, however, to the extreme rapidity with which rats reproduce 
themselves, destroying them either by traps or poisons, dogs or cats, 
is not the best way to combat them. Like all other animals, their ex- 
istence is dependent upon food, and if we can keep food away from 
them it is evident that they cannot remain long in such surroundings. 
Attention should be as thoroughly directed to making houses rat proof 
as to securing good ventilation and proper plumbing. From a stand- 
point of dollars and cents, barns should be constructed in such a way 
that rats cannot live in them. Board sidewalks in cities should never 
be permitted and public encouragement should be given all classes of 
people to absolutely annihilate the rat and to reduce the number of 
squirrels to the lowest possible number. 

If physicians will interest themselves in disseminating informa- 
tion of this character they can go far towards bringing about the great 
need which confronts us of good public sanitation. 



104 PUBLIC SANITATION AND OTHER PAPERS 



*RATS AND PUBLIC HYGIENE. 

The development of the science of bacteriology has profoundly 
modified our ideas in regard to the origin, cause and distribution of 
disease. It is to this science that we owe our knowledge of the meth- 
ods of contagion. No longer do we regard most diseases as due to 
atmospheric conditions; we no longer think of soil itself as being a 
cause of disease; and since the science of bacteriology has been devel- 
oped we have relieved the Creator of capricious responsibility. 

Educated people are becoming more and more impressed with 
the importance of accurate knowledge in regard to the relationship 
existing between living things. Increased knowledge of the habits and 
relationship of the mosquito has not only failed to make its bites more 
endurable, but it has shown us that the blood sucking habits of the 
mosquito constitute not the least reason for our objecting to that in- 
sect. We have learned that it is a carrier of several forms of malaria, 
of dengue, filariasis, yellow fever, and perhaps several other diseases 
of most serious character. 

Rats are not only highly destructive and offensive in many com- 
mon ways, but they are also the carriers of Bubonic plague and pos- 
sibly other serious diseases. The connection between rodents and the 
plague is a fact which seems to have long been known more or less 
clearly. If one will take the trouble to read the sixth chapter of the 
First Book of Samuel he will find that even at that early day the peo- 
ple attributed a serious pestilence which afflicted them to the presence 
of mice. It is quite possible that the word mouse might as well have 
been translated to read "rat" or "squirrel." 

In the great plagues of the Middle Ages more than one shrewd 
observer recorded the fact that rats suffered from the disease quite 
as much as did people. The origin of our common rat is wrapped in 
obscurity. It is quite probable that it originated in India. Its pres- 
ence in Europe is not clearly stated until about the time of the 
Crusades. It is possible that the rat was brought by the Crusaders 
from the East. Owing to the extent of modern commerce it has now 
become almost or quite world-wide in its distribution. There are few 
places in either North or South America which are not seriously in- 
fected with them. Wherever they are found they cause great destruc- 
tion of property. It would be a manifest impossibility to estimate 

*West. Ost., Nov., 1910. 



RATS AND PUBLIC HYGIENE 105 

with any degree of accuracy the damage done by them in the United 
States, but it would certainly run far up into the millions each year. 
The United States Biological Survey estimates the yearly destruction 
of property as being between thirty-five and fifty millions of dollars. 

Rats, and a number of other rodents, are subject to an epizootic 
which is highly destructive to them and which when communicated 
to men is called the Bubonic plague. Until the present world-wide 
epidemic of plague was recognized interest in rats was largely eco- 
nomical, but since the plague has passed to almost every civilized 
country and since this widespread disease is clearly traceable to the 
spread of rats, our interest in them is now very much more from the 
hygienic side than from the economical side. 

The United States Marine Hospital Service is doing splendid 
work not only in preventing the spread of diseased rats, but in adding 
to our knowledge of the relationship between these animals and 
human disease. Agents of the Marine Hospital Service are found in 
almost every port from which goods are shipped to the United States,, 
and great care is taken to prevent rats being transported with mer- 
chandise. Foreign countries are awakening to the importance of rat 
destruction. Denmark, Holland and England are especially active 
along these lines. In these countries the fear of trichinosis is quite 
as great as the fear of Bubonic plague, and this fear leads to the 
destruction of rats in inland cities as well as seaports. 

The Pacific Coast is a particularly favorable locality for rodents 
of all kinds and if our rats or squirrels should become widely infected 
with Bubonic plague it would be a task of no ordinary magnitude to 
rid the country of them. 

The marmots of India, animals rather closely related to the rats, 
are infected with the plague in a chronic form. In this form it is not 
necessarily fatal to the animal, but is readily transmitted to others, and 
when communicated to the human being may result in plague of the 
worst form. 

If we wish to escape a similar danger now is our time to reduce 
rats and squirrels in numbers. Every city should be surrounded by a 
wide zone entirely free from these animals. It is safe to say that none 
cf the small rodents are of the slightest economical importance and 
that every one of them is more or less of a menace to human health 
and development. 



106 PUBLIC SANITATION AND OTHER PAPERS 



*SEWAGE IN CALIFORNIA. 

The disposal of sewage is a vital question in our State at the 
present time. The public at large has come to understand so well 
the dangers from refuse matter that small towns which years ago 
would never have thought of a sewage system are now introducing 
them, and smaller towns all over the State are cheerfully bonding 
themselves to provide a proper sewer system. 

Much of the objection to cesspools is, in my judgment, ill-founded. 
The idea that the ground becomes polluted to such an extent as to 
make it dangerous is, in my judgment, hardly borne out by the facts. 
There are, as I understand it, two serious objections to cesspools. 
The first is that a cesspool is always in danger of overflowing. How 
nearly full a cesspool may be and when it will begin to overflow are 
questions impossible to answer. It is certainly true that when a cess- 
pool does overflow it becomes at once a menace, not only to the persons 
upon whose lot it exists, but to persons living in the immediate neigh- 
borhood. The second objection to the cesspool is that it represents 
an unnecessary and inexcusable waste of water. There is very little 
level land in California which cannot be made highly productive if it 
is properly supplied with water, and much of the water which is used 
for household purposes is just as good for irrigation as water from 
the mountain streams. 

The objection to using sewage for irrigation purposes is founded 
upon conditions which existed years ago, when methods by means 
cf which injurious bacteria in sewage could be destroyed were un- 
known. At the present time the well constructed, well managed septic 
tank has solved the problem along this line, and it is now possible to 
purify sewage to such an extent that it becomes absolutely innocuous, 
and of course in this condition it may be used for irrigating crops of 
any kind. I believe it is most wasteful for the larger and smaller cities 
to pump their sewage into the ocean. In every case I believe that it 
should pass through septic tanks until it is thoroughly purified and 
then be pumped or otherwise distributed for irrigation purposes. By 
doing this we would vastly increase our irrigation water and corres- 
pondingly increase the productiveness of the State. Every physician, 
as well as every other person who is interested in public matters, 

*West. Ost., May, 1911. 



SEWAGE IN CALIFORNIA 107 

should make himself acquainted with the modern septic tank and its 
possibilities. 

The theory of the septic tank is founded upon the fact that 
bacteria increase in enormous numbers in the presence of a suitable 
food supply when the temperature is favorable for their development. 
All of these conditions are met in the septic tank. The sewage which 
enters the septic tank is already bountifully supplied with bacteria, but 
in the presence of the great amount of organic matter in the sewage 
and at the warm temperature at which the sewage is maintained they 
increase with almost incredible rapidity. Of course, to do this they 
have to use an immense amount of food material, and as the supply of 
sewage is shut off from the tank during the time of fermentation it 
follows that the organic matter in the sewage is quickly destroyed and 
the bacteria perish. Thus the sewage is rendered sterile and in this 
form may be safely used for almost any purpose. The principle of the 
septic tank is closely comparable with the condition of an iron warehouse 
in which there is a great quantity of grain and water stored, conditions 
which would be highly favorable for rats or mice. If a few of these 
animals are present, it is easy to see that they might rapidly increase 
in numbers in the presence of the abundant food supply, but if no 
more grain were added the rapid increase of the animals would only 
mean hastening the time when, they must starve to death. 

A septic tank properly constructed and managed is not seriously 
offensive so far as smell is concerned and there is no danger from its 
bacterial content. Certainly this method of disposing of sewage will 
make possible a sewerage system in inland towns from which the 
drainage of sewage would be absolutely impossible. 



Just now we are all deeply interested in regard to the real truth 
about many new methods of treating disease. We know that there 
are great monetary interests behind these. To what extent many hon- 
est physicians are mistaken in regard to the supposed results we do not 
know at this time, but if we shall ultimately find that the effects of 
these things are radically different from what is popularly believed 
we would only be in strict harmony with previous experiences through 
which people have passed. 



108 PUBLIC SANITATION AND OTHER PAPERS 



^HEALTH AUTHORITY AGAINST CESSPOOLS. 

The evils of sickness constitute the most grievous tax which any 
community can be called upon to pay. No tax collector is more abso- 
lutely heartless and relentless than disease. This stern agent is abso- 
lutely without sympathy and remorselessly exacts his dues to the 
uttermost. 

There is no cause of disease which confronts our city at the 
present time which is so dangerous to us as our cesspools. So long 
as there are no wells in the city and so long as the cesspools are well 
drained, they constitute an unobjectionable method of disposing of 
sewage, but the evil of the cesspool is that it becomes filled at the most 
unexpected moment and then its contents are spread over the surface 
of the land and in that way become extremely dangerous. Experience, 
not only here but elsewhere, has conclusively shown that cesspools are 
seldom replaced until they have become full and run over and then no 
matter how vigilant the owners finally may be in having a new cess- 
pool dug, the old one continues for a number of days to menace not 
only the health of the family to whom it belongs, but also the health 
of the neighborhood. 

Not only are cesspools dangerous because of the certainty of their 
continually filling, but they are also expensive for the same reason. 
From the mere standpoint of dollars and cents, sewers are in the long 
run cheaper than cesspools. A proper sewage system once installed 
settles the problem of sewage for all time, while as before stated the 
best constructed cesspool is only a makeshift and must be in a short 
time replaced by another. 

There is no finer example in the world of the possibilities of a well 
constructed sewage system than are to be found in the city of Rome. 
Here the Cloacus Maximus, the main sewer of the city which was 
constructed in almost pre-historic times, still continues to be used as 
the principal outlet of the sewers of Rome. While it is hardly to be 
expected that we will build a sewer which will be of such durability, 
still we owe it to ourselves, to our posterity and to the future growth 
of the city, to construct a good and sanitary sewage system, and while 
this will cost us something at first, it will be in the long run our cheap- 
est method of disposing of our waste matter. Casting all sentiment 
aside, one outbreak of typhoid fever, such as we may have at any time 
from a cesspool system, might cost us in dollars and cents a sum which 

*So. Pas. Rec, Sept., 1913. 



CRIMINALS AND SICKNESS 109 

would go far toward putting in a system which would almost make 
epidemic diseases of that kind an impossibility. 

I wish to say in strongest possible terms that the time has come 
when any city should feel itself disgraced by a widespread outbreak 
of typhoid fever or of most other infectious diseases. We have a 
beautiful residence city. We are going to continue to live here. Let 
us unite in doing all that we can to make it healthy and happy for our- 
selves and for our neighbors. 



^CRIMINALS AND SICKNESS. 

It is probably no exaggeration to say that the heaviest tax which 
we are called upon to pay is the tax levied by criminals and by sick- 
ness. At the congress held in Washington in October to consider the 
care of criminals it was stated on what was supposed to be good 
authority that the annual cost of crime in the United States is not less 
than $6,000,000,000. This is nearly one-third more than the value of 
all the corn, wheat, cotton and hay produced in 1909. It was also 
stated that the loss of life occasioned by crime each year amounted to 
not less than eight thousand people. 

A conservative estimate of the cost of sickness each year places 
the estimate at not less than $1,500,000,000 with an average of 3,000,- 
000 sick people continually on our hands. In other words, our. crim- 
inals and our sickness costs us more than $7,000,000,000 each year. If 
any such tax upon our prosperity were necessary, we ought, of course, 
to assume it without complaint, but when we reflect that the greater 
part of this enormous tax is due to preventable causes we can readily 
see that it is a burden which we should not carry. 

Prof. Adolph Prins of Belgium, one of the most profound crimi- 
nologists in the world, said in a recent address, "Society has no more 
criminals than it deserves." In other words, he regards crime as pre- 
ventable, partly by wise legislation and partly by improving the 
physical condition of the people. 

There is no other profession which should be as much interested 
ill the prevention of crime and sickness as the medical profession, and 
there is no class of people who should study sociology and hygiene in 
the broad sense of those terms as thoroughly as should the physician. 
There is no reason why the Osteopathic physician should not make his 
influence profoundly felt along these lines, and if we are not lacking 
hi enterprise and rational patriotism we shall do our utmost to aid in 
forwarding the work of criminal reformers and hygienists. 

*West. Ost_ Dec, 1910. 



110 PUBLIC SANITATION AND OTHER PAPERS 



^INFECTION BY MEANS OF WATER AND MEAT. 

The Broad Street Well of London is as much a classic to the public 
hygienist as is the tip of the onion to the student of cell division. In 
1854 there was a serious outbreak of cholera in the Parish of St. James 
in London. The outbreak was so serious in character and the death 
rate was so high, that it led to a careful investigation being made as to 
the source of the disease. After a long and critical investigation it was 
found that almost all cases of cholera in the parish were those who 
drew their supply of water from this well. In this parish there was a 
workhouse containing 535 inmates ; among these scarce any cases of 
cholera developed. There was a brewery employing seventy workmen 
who were practically free from the cholera. In both of these cases, 
water was drawn from private supplies. As analysis proceeded in these 
cases, it was found that it was only those who secured water from the 
Broad Street Well who were severely suffering from the epidemic. 
When an investigation was made in regard to the water supply of the 
well, it was found that drainage pipes from a number of houses passed 
almost over the top of the well and that these pipes were seriously 
cracked within a few feet of the edge of the well, thus permitting 
sewerage matter to pass almost directly into the water. The last link 
in the chain of evidence against this well seemed to be forged when it 
was found that a visitor in one of the houses from which these drain 
pipes came, had come to the house suffering from a well-marked case 
of cholera about two weeks previous to the outbreak of the disease. 
This is perhaps the first case where contagious disease was positively 
traced to water supply. Previous to this time many hygienists had sus- 
pected the dangers of polluted water and much had been written in re- 
gard to the desirability of pure water, from the time of the Mosaic law 
up to our own day, but the evils had been suspected rather than definite- 
ly proven. 

Two European cities, Hamburg and Altona, formed practically one 
municipality, lying on the two sides of the Elbe river. Hamburg derives 
its water supply directly from the river ; Altona filters its water carefully 
before using it. In 1892 Hamburg suffered severely from cholera, while 
Altona remained almost entirely free from the disease. As all other 
conditions in the two cities were practically the same, it seems almost 
certain that the freedom of Altona from the disease was due to the 
greater care exercised in protecting the drinking water. 

It is from cases of this kind that we learn the possibility of cities 

*Jour. A. O. A., Aug., 1913. 



INFECTION BY MEANS OF WATER AND MEAT 111 

protecting their citizens from disease, and no higher duty can devolve 
upon any city than to intelligently exercise this precaution. We have 
already advanced to the stage where the individual may insist that he 
be protected from dangerous holes in the road and from defective 
bridges. It is only a short step to the time when he will demand that 
he be protected from communicable disease. It is as manifestly impossi- 
ble for the traveler to take the necessary precautions to protect himself 
from disease, as it is to make examinations which will protect him from 
defective bridges. When little or nothing was known of the method of 
communicating disease, such protection was impossible; now the pro- 
tection against many diseases is simply a matter of exercising a sufficient 
amount of care. 

It is evident that all that has been said in regard to cholera may be 
said with equal or greater force of typhoid fever. All excreta from 
patients suffering from this disease is known to be rich in typhoid 
bacilli, and a small amount of matter thrown on the surface of the 
ground in the mountain camp may pollute the river many miles away 
and the polluted river, either through its water or its ice, may spread 
contagion far and wide. Our smaller towns stand in particular danger 
of water-born disease, because it is so common for them to get their 
water from wells and to have cess pools which are frequently nearly as 
deep as the wells. Many cases of children's disease can undoubtedly 
be traced to sources of this kind. 

Diphtheria, scarlet fever, and probably measles are readily dissem- 
inated by milk when it is handled by those who are suffering from any 
of these diseases. It seems to be well established that both tuberculosis 
and anthrax are also spread by milk. 

It now appears that meat may be a menace in at least two different 
ways. It is very certain that there are a number of pathogenic bacteria 
belonging to the colon group which may infect meat and which may be 
transmitted to those who use it as food. Few cases of this kind have 
been reported in this country, but a number of well authenticated cases 
have appeared in Europe. It is not easy to see how a consumer is to be 
perfectly protected from danger of this kind. It is quite likely that 
animals, as well as people, may act as "carriers." That is, they may 
transfer bacteria without themselves apparently suffering from the 
infection. 

The other danger in meat is in the post mortem changes which may 
occur in it. It is easy to provide against these dangers; indeed, the 
problem is very largely solved by cold storage under proper supervision. 



112 PUBLIC SANITATION AND OTHER PAPERS 

Personally, I believe that the danger from animals infected with tuber- 
culosis is much less than is popularly believed. We have built up an 
elaborate system of meat inspection and it is so thoroughly entrenched 
in the good graces of our people that it is rather a thankless task to 
assail it. While I do not believe that it accomplishes very much good 
along the line that it was intended to accomplish, it may do so much 
collateral good in making the slaughter houses clean, doing away with 
the cruelty and unspeakable filth which once characterized these places, 
that the inspection may be worth all it costs and even much more. I 
fully believe that eating tubercular meat is much more of an offense to 
the esthetic senses than it is an offense to the laws of health. This be- 
lief is based upon the fact that it has been impossible to secure any 
well authenticated cases of persons contracting tuberculosis in this way, 
and further upon the theoretical consideration that the bacillus of tuber- 
culosis is extremely sensitive to heat and that it is killed by any ordi- 
nary process of cooking. It is almost universally true, that let any belief, 
no matter how intrinsically absurd, once get deeply rooted in the public 
mind, there always seems to be plenty of evidence to confirm and per- 
petuate it. This is especially true when great financial interests are at 
stake. 



It is a little amusing to the student of human nature to notice how 
some people seem to believe that all wisdom belongs to the past, and 
to notice how others fail to give the past credit which is its due. Many 
of us who are students of modern science really appear to believe that 
all knowledge belongs to our own day. If a book bears the date of 
ten years ago we regard it as too modern for the museum, but entirely 
too old for the library. Much of this feeling is without just founda- 
tion. It is now more than two hundred years since careful physicians 
have known that some diseases are due to animal infection. When 
this discovery was made the educated physicians of the period quickly 
jumped to the conclusion that all diseases were due to animal infec- 
tion. As the methods of research then employed did not reveal the 
parasites causing disease, a long period of doubt ensued, and the 
origin of disease being due to infection was not discussed again until 
almost our own day. 



FOOD PRESERVATIVES 113 



*FOOD PRESERVATIVES. 

Few subjects are more widely discussed at the present time than 
the purity of food and the best means for its proper preservation. 
The subject is of far-reaching importance, and is by no means easy 
of solution. The natural difficulties surrounding a condition so com- 
plex are greatly increased by commercial interests, which are deeply 
involved, and also by well-meaning men and women who possess little 
real information, but who are anxious to make themselves heard. 

In the newspapers, and even in some periodicals, which should 
be taken a little more seriously than we take the daily press, the terms 
"natural preservatives" and "chemical preservatives" are frequently 
used. 

Before entering upon any discussion of the preservation of food, 
I wish to say a few words in regard to the causes leading to its decom- 
position. These causes now appear to be two-fold. One of these is 
the omnipresent micro-organism, spores of the various molds, bacteria 
and protozoan animals. These are everywhere present in the air, and 
unless complicated precautions are taken they readily fall upon and 
into all kinds of food material, and if the food material offers them 
an opportunity for growth, they straightway proceed to develop and 
increase in numbers, and by using the substance upon which they are 
growing for their own food, they quickly bring about its decomposition. 
These are the most active and most clearly recognized agents of food 
destruction, and until comparatively recently they have been the only 
clearly recognized causes of decomposition, but recent investigation 
has shown that many cells produce within themselves ferments or 
enzymes, which will eventually change the chemical structure of the 
cell, sometimes fitting it better for human consumption and sometimes 
rendering it utterly unfit for food. The changes brought about by 
these substances which are within the cell are known as autolytic 
changes. The ripening of fruit after it is picked, the increasing juici- 
ness of the lemon, the better flavor of meat, the increasing sweetness 
of the grape, fig and orange, are all examples of autolytic changes. 
The final decomposition of meat, the decay of fruit and the souring of 
milk are all examples of changes brought about by bacteria. Since 
the changes (autolysis) are due to substances inherent in the living 
cell, it is manifestly impossible to protect substances subject to these 
changes from autolytic action, but whenever it is desirable to do so, 

*West. Ost., Aug., 1910. 



114 PUBLIC SANITATION AND OTHER PAPERS 

autolysis may be delayed by keeping the food in cold storage ; under 
such conditions, autolysis proceeds very slowly. Many fruits are pro- 
tected from bacterial invasion by the character of their rinds. Ex- 
amples of this are found in the various citrus fruits, apples, pears, 
cherries, etc. Unless the skins or rinds of these fruits are abraded in 
some way, they are in little danger of bacterial invasion until autolysis 
is complete. In many cases the autolytic changes have seriously 
affected the integrity of the covering, and bacteria and molds are then 
able to penetrate. 

From what has been said, it will readily be seen that cold storage, 
together with the preservation of the integrity of the skin and wrap- 
ping in such a way as to exclude bacteria, etc., are the best methods for 
the preservation of fruit. Cold storage will also check the autolytic 
changes which take place in meat and will greatly retard the growth 
of bacteria producing putrefaction. There are of course many chemi- 
cal compounds which may be used to check bacterial growth in meat 
and other foods. Among the many preservatives thus used, formalin 
has occupied an important place. The place of formalin has been im- 
portant not only because it is singularly efficient as a preservative, but 
because its effect upon the human system are unquestionably deleter- 
ious. This has been so definitely established that its absolute prohibi- 
tion is fully justified. Another efficient preservative is sodium ben- 
zoate. This acts as a preservative when present in very minute quan- 
tities. Sodium benzoate is a white, odorless, sweetish, astringent pow- 
der ; it is highly soluble in water, and the most careful experiments have 
failed to demonstrate that it has any appreciable effect upon the human 
body, especially when used in the minute quantities, as is done in the 
preservation of food. 

It has long been known that spices like cloves, nutmeg, cinna- 
mon and allspice are preservatives of organic substances. Spices have 
been used more or less in embalming human bodies, and the housewife 
makes free use of some of them in foods which she desires to keep. 
The preserving effects of these spices appear to be due to an essential 
oil which they contain, and which is readily extracted by the foodstuffs. 
Used in great moderation, it is probable that little real harm can be 
attributed to them, although it is a little absurd for people who use 
strong spices to object to sodium benzoate. Their tolerance of the one 
is born of long acquaintance, and their intolerance of the other is due 
to the fact that it has a chemical name. 

The time is probably not far distant when many of our foods will 



PRESERVATION OF FOOD SUPPLIES 115 

be manufactured. We are rapidly learning how to build up complex 
nitrogenous compounds, and it is quite possible that manufactured 
proteids may some time take the place of the proteids which we now 
derive from vegetable and animal sources. When that time comes, the 
question of food preservation will perhaps be less important than it is 
at the present. 



^PRESERVATION OF FOOD SUPPLIES. 

It is a fact of world-wide recognition that the cost of living has 
seriously increased during the last twenty-five years, and there is some 
reason to fear that the cost may increase still more. This presents 
a very serious problem to the vast majority of the people, and the wel- 
fare of society demands that a thorough investigation be made and 
that we shall bring the cost of living down to a figure which is com- 
mensurate with the incomes of the majority of the people. It is probable 
that this increased cost of living is not due to any one factor. The large 
areas of highly fertile land devoted to the production of tobacco and of 
grain used for the production of intoxicating liquors is unquestionably 
one cause of the high cost of living. If this land and the labor now de- 
voted to it were put into the production of foodstuffs, it requires no 
argument to show that the cost of living would be materially lessened. 

One factor which is tending to lower the cost of living is our in- 
creased ability to preserve perishable foodstuffs. By means of our 
refrigerator cars it is possible to transport tropical fruits to the colder 
regions of the North, and this not only adds to the comfort of the 
people, but materially to the lessening cost of living. At the present 
time it is estimated that more than three thousand million of dollars 
of food is continually in cold storage. At least one-half of this great 
value is represented by meat. Milk is an extremely perishable food, 
but the butter and cheese derived from milk may be preserved for a 
long time. The value of milk as a food can also be preserved by evap- 
oration ; the same is true of eggs, but in order that either milk or eggs 
shall be valuable in a preserved state they must be in good condition 
when they pass into the hands of the preserving company. Contrary 
to popular belief, bacteria very readily penetrates the shell of the egg. 
Many of these bacteria are practically harmless, but if they are allowed 

*West. Ost., Oct., 1912. 



116 PUBLIC SANITATION AND OTHER PAPERS 

to accumulate in large numbers, they will almost inevitably destroy 
the value of the egg as a food product. It is a well known fact that 
if an egg be held near a burning lamp and examined through a tube, 
dark spots can be seen in eggs which are beginning to spoil ; these dark 
spots are in reality masses of bacteria, and if there are many of these 
masses of bacteria the dry product of the egg is materially lessened in 
value for food. Denmark at the present time is experimenting freely 
in exporting frozen milk. This frozen milk finds its way into the 
markets of continental Europe and England, and is regarded as a 
most valuable food. 

There are five principal methods now employed for preserv- 
ing food. The first method is by the use of harmless preserva- 
tives : the use of sugar and vinegar, various spices and oils, are 
examples of this method. The second method is by the use of chemi- 
cal preservatives ; of these sodium benzoate, formalin and salicylic acid, 
and boric acid, are the most important. It is still an open question as 
to the effect of these preservatives upon the human body. In a general 
way it certainly seems best to avoid the foods preserved by this method 
until we shall be sure that no evil effect follow their use. The third 
method of preserving food is by heat ; this is employed in all processes 
of canning fruit, and is based upon the principle of heating the fruit 
until the bacteria are destroyed, and then sealing it up in such a way 
that none may enter; in this way fruit may be almost indefinitely pre- 
served. Closely related to this method is pasteurization, which consists 
in heating milk, or any other food material, to a temperature of about 
one hundred forty degrees and maintaining this heat for a period of 
twenty minutes or more, and then rapidly cooling the material. By 
this process large numbers of bacteria are destroyed, and the food in 
consequence will remain for a considerable length of time unchanged. 
The fourth method of preserving foods has already been alluded to, 
and that is by desiccation, or drying. Meat, eggs, milk and fruit are 
all more or less successfully preserved in this way. The fifth and last 
method of preserving food is by low temperature. When the tempera- 
ture of food is reduced nearly to the freezing point bacterial activity 
practically ceases, and in this way food may be almost indefinitely pre- 
served. 

When we remember that one bacterium may, under favorable 
conditions, give rise to more than ten million descendants in twenty- 
four hours, and that practically all decay is due to bacterial action, 
we can understand the supreme importance of limiting their increase. 



PRESERVATION OF FOOD SUPPLIES 117 

On the other hand it is comforting to remember that most kinds of 
bacteria produce decay very slowly, and no matter how numerous 
they may be they produce little or no effect if taken into the human 
body. This brings us to a special consideration of the cold storage 
problem. The present cold storage system has evolved from the New 
England cellar; and as the cellar in the old days was the store-house 
wherein food abundant in the fall might be cared for and slowly used 
during the winter, so the cold storage plant has become a most im- 
portant place for the conservation of food in seasons of plenty, and a 
place from which it may be drawn as the outdoor supply diminishes. 
Cold storage has now become a matter of so much importance that the 
Canadian government subsidizes cold storage plants in the large cities, 
and thus makes it possible for people to procure cold storage foods 
at a much lower price than they otherwise could. 

It is evident that different kinds of food must be preserved at 
different temperatures. Fruits, vegetables and eggs in the shell, would 
be seriously injured should the temperature fall below the freezing 
point ; on the other hand mixed eggs — eggs which have been taken out 
of the shell and the white and yolk mixed — may be frozen without 
injury. Whether one is dealing with the whole egg or with mixed 
eggs, it is important that the eggs should be good. April and May 
eggs taken from the cold storage plant six months after they are laid 
are really better than the summer eggs which are taken from the 
poultry yard to the store and sold four or five days after they are laid. 

There are two methods employed in the cold storage of poultry; 
one is known as the dry method, and the other is the wet method. 
When the wet method is employed, the birds are immediately packed 
in ice, and sent in that way to the cold storage plant. The objection 
to this method is that the skin is more or less broken by the ice, and 
in that way the entrance of bacteria is made easier if they are kept for 
any length of time without being frozen. In the dry method the dead 
birds are simply kept cold until they are placed in cold storage. Sani- 
tarians are discussing most earnestly the advantages and disadvantages 
of dressing poultry before placing it in cold storage. At one time the 
argument seemed to be most strongly in favor of dressing the birds 
before freezing them, but further investigation has shown that the best 
results are obtained by freezing the birds before dressing, and then 
slowly thawing them and dressing them just before they are cooked. 
There seems to be little good reason for the feeling of prejudice ex- 
isting against cold storage chickens, or indeed meat of any kind. It is 



118 PUBLIC SANITATION AND OTHER PAPERS 

highly probable that the chicken that has been in cold storage for a 
year has undergone less deleterious change than has the bird in the 
grocery which was killed two days before it was sold. 

Beef, pork and mutton are now well kept in cold storage plants. 
The usual process which is followed is to place the meat at once in the 
"chill room" for one day; the temperature of this room varies be- 
tween 32° F. and 40° F. ; the meat is next moved to the "freezer", 
where the temperature is from 9° to 12° below zero, F. ; in this room 
the meat is kept for three or four days, until it is thoroughly frozen; 
it is then removed to the "cold storage room", which has a temper- 
ature of from 12° to 15° F., and there it may be kept indefinitely. 
Changes take place very slowly while meat is in cold storage. There 
is probably a continuous, though very slow chemical change, which 
brings about the peculiar condition of meat known as ripeness ; this is 
beneficial rather than injurious to the meat. In order that the cold stor- 
age plants may render the best service, two things are necessary ; first : 
Cold storage warehouses should be subjected to government inspec- 
tion, as to construction, ventilation and temperature, and sanitary con- 
ditions. This inspection should also be extended to refrigerator cars. 
Second: All food designed for cold storage, should be carefully in- 
spected before being committed to the warehouses. Could these con- 
ditions be met we should have little reason to complain of cold storage 
products. 



*PROOF OF CONTAMINATION OF FOOD. 

It is often a matter of great importance to be able to determine 
whether or not a community stands in danger of infection from typhoid 
fever and from other dangerous intestinal diseases. Until recently, 
about the only way this question could be answered was by waiting 
and seeing. There is however, a practical test which may be applied 
to the solution of this problem, and that is by observing the presence 
or absence of certain protozoa in fecal matter. Entameba coli, Lamblia 
duodenalis and the Trichomonas intestinalis are all intestinal para- 
sites, and so far as I know, they do not live for any length of time out- 
side of the alimentary canal ; hence their presence in fecal matter is an 
indication that the person from whom this matter came had ingested 
fecal matter from some other person infected by these parasites. It 

*West. Ost., April, 1913. 



PROOF OF CONTAMINATION OF FOOD 119 

is not difficult for a biologist to recognize these forms with almost 
absolute accuracy. There are at least two ways by means of which 
these parasites may be spread from one person to another. The first 
way is by the fly, which not only breeds in fecal matter, but readily 
resorts to it for food. The second way is by the fecal matter becoming 
dry, and these parasites being carried about on dust while they are 
in the spore stage of their development. To make this matter a little 
more clear, I am going to call attention to five facts connected with 
these organisms : 

1. They are strict parasites, not known to reproduce outside of the 
alimentary canal. 

2. Any person infected must acquire his infection from some 
person already infected. 

3. These parasites are readily discharged from the body with 
the feces. 

4. The spores are sufficiently small to be readily carried by flies. 

5. Flies breed in, and readily visit, fecal matter. 

It really seems that the chain of evidence is quite complete. Re- 
ports show that in many towns from 10% to 60% of the people show 
the presence of these parasites. These parasites themselves are not 
likely to produce serious results. Two of them, at any rate, usually 
produce no appreciable result of any kind, but the conditions which 
are favorable for carrying these parasites from one person to another 
are equally favorable for spreading typhoid fever and the various in- 
testinal diseases from which children especially are so likely to suffer. 
The presence of these parasites is always an indication of poor sanitary 
arrangements, and wherever they are widely found, attention should 
be immediately given to improving sanitary conditions. While there 
is always a possibility that these organisms may be shipped from one 
place to another on articles of food, the fact still remains that this is 
certainly not the common way for them to be dispersed. Wherever 
these parasites are found, the meaning should be quickly understood by 
the health authorities and the action which should follow may be ex- 
pressed in two words : Clean Up. 



120 PUBLIC SANITATION AND OTHER PAPERS 



*WATER AS A CARRIER OF DISEASE. 

Among the various dangers to which humanity is subjected, none 
is more subtle than the "cup of cold water." Next to the air which we 
breathe nothing is more necessary for the immediate continuance of 
life than water and unfortunately air and water are the most frequent 
bearers of pathogenic organisms. 

From the very nature of the case, we might rightly infer that dis- 
eases having their seat in some part of the alimentary canal would be 
the ones which would be the most frequently transmitted by means of 
water. It is true that septic bacteria from wounds and expectorated 
matter from the lungs and air passages laden with pathogenic bacteria 
may find their way into water and be ingested, but in most cases these 
bacteria are inert in the alimentary canal, while the bacteria which have 
caused the various diseases affecting the alimentary canal would not 
unnaturally be returned to water, and if this infected water is in any 
way mixed with drinking water it is easy to see how disastrous results 
may follow. 

In a critical discussion of sanitation it is necessary to distinguish 
between polluted waters and infected waters. By polluted water is 
meant that which holds decomposed or decomposing organic matter, 
either in suspension or solution, but may be free from pathogenic bac- 
teria. By infected water is meant that which contains pathogenic bac- 
teria. In almost every case infected water is polluted, but it does not 
necessarily follow that polluted water is infected. In a vast majority 
of cases both infection of water and the pollution result from con- 
tamination by sewage. 

Many people regard rain as it falls from the clouds, and water de- 
rived from melting newly fallen snow, as almost absolutely pure. 
Careful investigation shows that this is not the case. Both organic 
and inorganic matter is found in such water, and both kinds of matter 
are washed out of the lower strata of the air. Damp snow acts as a 
filter and water from this source not infrequently is heavily laden with 
dust and is very rich in many kinds of bacteria, pathogenic forms being 
among the number. I have in more than one case found rotifer worms 
and various forms of infusoria in water obtained from melting newly 
fallen snow. 

Of all diseases not one has been more certainly traced to infected 

*Ost. World, Aug., 1905. 



WATER AS A CARRIER OF DISEASE 121 

water than typhoid fever. The history of this disease is long and in- 
teresting, and its various chapters are highly illustrative of the methods 
followed by true scientific workers. On three continents, North Amer- 
ica, Europe, and Australia specific epidemics of this disease have been 
investigated, with the result of tracing the infection to the supply of 
drinking water. It is only proper to say that water is not the only 
source of infection, for more than one most serious epidemic has been 
traced to raw oysters. 

Aside from typhoid fever the diseases which have been most clearly 
traced to infected water are Asiatic cholera, dysentery and various 
forms of diarrhoea. It is probable there are several other diseases 
which are frequently acquired from impure water. Among these may 
be named tuberculosis, and actinomycosis. 

It has already been stated, that water obtained from newly fallen 
snow may be dangerously infected. Water obtained from ice may also 
be dangerous. Careful experiments have shown that pathogenic as well 
as nonpathogenic bacteria may remain frozen in ice for an indefinite 
period of time without suffering any loss of vitality. This being the 
case it is easy to see why the source of ice should receive the most care- 
ful attention. Not only is this true of ice cut from streams and lakes, 
large and small, but it is true of manufactured ice, as this is free from 
dangerous bacteria only when it is made from pure water. So far as 
I know there is no rough and ready means of determining at all times 
the fitness of water for household use. Many physicians rely on what 
they call the "Potassium permanganate test." This is made by observ- 
ing whether or not the water reduces the permanganate, the reduction 
being determined by the change in color in the solution of the perman- 
ganate. Certainly no water which decolorizes the permanganate is 
fit for culinary or drinking purposes, but it by no means follows that 
all water which does not decolorize it is potable. The fitness of water 
for domestic use can only be determined by a competent chemical, 
microscopical and bacteriological examination. 

It is by no means easy to render contaminated water fit for use. 
For immediate results nothing is probably more effectual than to boil 
the water, but this is at best only a make shift and its good effects are 
only temporary. If the air contains any considerable number of bac- 
teria, especially the bacillus of typhoid fever the water may contain 
more twenty-four hours after it has been boiled than it contained be- 
fore boiling. 

Any real remedy for defective water must extend back to the 



122 PUBLIC SANITATION AND OTHER PAPERS 

source from which the water is derived. The most careful experiments 
and observations have shown that water is to a greater or less extent 
self purifying. The earlier thought was that this purification was 
brought about by a process of oxidation and that falls and rapids in a 
stream were favorable to rapid purification. We know now that water 
is most rapidly freed from its living burden in the quiet, slowly flowing 
places. That in these places the organic matter upon which the organ- 
isms live, settles slowly to the bottom and the organisms themselves 
die partly from the want of proper food and partly from the effects of 
the sunlight, which is singularly fatal to almost every form of bacterial 
life. 

Careful study has shown that there is much less danger if the 
sewage of a city is turned into a slowly flowing river, and one hundred 
miles below water for domestic uses is taken from the same stream, 
than if the same sewage had been turned into a rapidly flowing river 
in which there are numerous water falls, and the water withdrawn as 
in the former case. It is probably a mistake for the smaller cities and 
towns to have covered reservoirs. It is true that the cover keeps out 
considerable dust and foreign matter of various kinds, but it also pro- 
tects the water from the light of the sun. There is no germicide known 
which is equal to the strong, clear light of the sun. 

It seems needless to remind physicians that of all people they 
should most thoroughly understand public hygiene. Their most imme- 
diate duty may be to those who are sick, but it is no less their duty in- 
telligently to point out those errors in public sanitation which most 
inevitably lead to wide spread epidemics. 



We have in our imagination seen the look of consternation which 
crossed the faces of Jewish bigots when they were told that "the Sab- 
bath was made for man and not man for the Sabbath." The same 
look comes across the faces of many modern physicians when they are 
told that their profession exists for the purpose of aiding in the allevi- 
ation of disease and that disease does not exist for the sake of helping 
men and women of a certain profession to make a living. 



GOOD WATER 123 



*GOOD WATER. 

The value of living is measured by efficiency, and efficiency is very 
largely dependent upon physical health. To a certain extent the pres- 
ervation of health is a duty which falls upon each individual but there 
are some factors upon which health is dependent that the individual 
cannot properly supervise, and these factors must either be neglected 
or they must receive the attention of those invested with public author- 
ity. Few things are more essential to public health than a pure and 
plentiful supply of water. At least two things are necessary to an ideal 
water system : 

First, the water must be in a pure and uncontaminated condition 
as it comes from its source, and 

Second, it must be stored in clean and properly constructed tanks 
or reservoirs. 

The outlet of the reservoir should always be a foot or more above 
the bottom so that whatever dust and dirt gets into the reservoir may 
settle below the outlet. It is true that the reservoir will keep clean much 
longer if the water is drawn from the bottom, but of course it keeps 
clean at the expense of the water it supplies, as under this condition all 
of the dirt passes out into the pipes supplying houses. Reservoirs 
should be carefully covered and screened so that not only small animals 
are excluded but also insects of all kinds, as otherwise the water be- 
comes contaminated with their larvae. Southern California is becoming 
so thickly populated with tubercular people that organic matter of all 
kinds should be regarded with suspicion, and public reservoirs into 
which dust and debris fall are a menace to public health. It is a matter 
of vital importance to the citizens of South Pasadena to see that their 
water supply is made and kept as good as it possibly can be. The ex- 
pense connected with maintaining a proper water supply is very small 
compared with the expense which would be entailed by an epidemic of 
typhoid fever, or by occasional cases of tuberculosis. Proper regula- 
tions along this line can only be obtained by the intelligent co-operation 
of all public spirited citizens, but by such co-operation all that is neces- 
sary can be secured. 



So. Pasadenan, Oct., 1907. 



124 PUBLIC SANITATION AND OTHER PAPERS 



*COLD WATER. 

Until recently there has been an absolutely senseless fear of cold 
water. Fortunately for suffering humanity, the attitude of the public 
is now undergoing a marked change. Almost all primitive theological 
systems teach that whatever we like is necessarily bad, and this idea 
seems to have been thoroughly grounded in the race. Recently, how- 
ever, saner views are being accepted and we no longer deprive patients 
burning with fever of the blessings of cold water. We have learned 
that ice water is as beneficial as it is agreeable, and we have also 
learned that ice cream promotes digestion rather than retards it. 
While the first effect may be to contract the blood vessels of the stom- 
ach and so produce an anemic condition, we know that this is imme- 
diately followed by a reaction which brings on a hyperemia highly 
favorable for digestion. We have all been seriously warned against 
the evil of drinking water with our meals, but the most recent investi- 
gation has shown that a moderate amount of fluid taken during the 
mealtime is beneficial rather than injurious. Within reasonable limits, 
the amount of gastric juice secreted by the stomach keeps in close re- 
lationship with the amount of fluid which one swallows; and thus the 
digestive power of the stomach is increased by drinking rather than 
decreased. The power of absorption is certainly greatly increased by 
drinking. The fear of the cold bath when one is warm is entirely 
without foundation. If one is overheated, either from fever or from 
over-exertion, there is nothing better than cold water to reduce the 
temperature. There may be individual cases where care would have 
to be used in the application of cold water, either internally or ex- 
ternally, but the statements herein made are certainly true for the 
great majority of people. A cold draught of air, providing it strikes 
the greater part of the body, is injurious in proportion to the amount 
of dust which it carries ; without the dust, little harm is likely to come 
from it. In general, we are safe in reversing the old rule ; and instead 
of feeling that whatever we enjoy is necessarily bad, we should feel 
that whatever we enjoy is good, and that it is good because we 
enjoy it. 



'West. Ost., Sept., 1913. 



MILK 125 



*MILK. 



There is a marked tendency to give increased attention to the 
sanitary condition of milk and milk products. This is especially marked 
in the United States. In a few European countries, Switzerland, Bel- 
gium and Holland, and to some extent in England, milk and milk prod- 
ucts have long received careful attention, and in consequence of this 
milk-borne diseases are rare in these countries. 

Milk is an almost universal food, and while there is some question 
as to its supreme value for healthy people engaged in ordinary work, 
there is no doubt of its great value for the sick and convalescent and 
it, of course, forms the only natural food of infants. 

The rate of mortality among grown people and among children 
after the first year or two of life has been greatly diminished, but the 
mortality among infants under one year of age is still enormously 
great and a large proportion of those who lose their lives thus early 
die as a result of gastro-intestinal diseases, and these diseases are al- 
most invariably due either to infection from food or to chemical poisons 
formed in food by bacterial action. 

There was a serious outbreak of typhoid fever in Washington, 
D. C, in 1906. Public opinion in that city demanded a careful inves- 
tigation as to the cause of this outbreak, and the investigation which 
followed was conducted from a broad standpoint and much light was 
thrown upon milk-borne diseases. The investigation not only showed 
that milk might act as a carrier of infection, but it showed how the 
infection might be communicated to the milk and how, as the result 
of infection, even by non-pathogenic bacteria, deleterious compounds 
might be formed in the milk. 

Milk in the udder of the cow is almost or quite free from bacteria, 
but the lower portion of the milk duct harbors large numbers of bac- 
teria; so before the milk is really drawn to the surface it becomes in- 
fected. The air in and around cow stables contains large numbers of 
bacteria which readily drop into the milk, and every particle of dust 
and filth from the cow is well loaded with bacteria, so as a general 
thing large numbers of these organisms are introduced into the milk 
before the milk leaves the stable. 

Milk is a very excellent culture medium for bacteria and hence 
the number of bacteria is very rapidly increased. 

Recent investigations made of milk in St. Petersburg, Russia, 

*West. Ost., Oct., 1910. 



126 PUBLIC SANITATION AND OTHER PAPERS 

show that the average milk there contains from 10,200,000 to 82,300,- 
000 bacteria to the cubic centimeter. When one remembers that twenty- 
five drops of milk will make about one cubic centimeter, some idea can 
be formed as to their immense numbers. Investigations of milk made 
in Liverpool show that ordinary milk there contains about 17,000,000 
to the cubic centimeter. The average in London is 31,880,000. The 
greatest amount found in milk publicly offered for sale in Washington, 
D. C, was 307,800,000, with an average of a little more than 22,000,000. 
If milk were at all transparent, such numbers of organisms would make 
it so murky that it would be nearly or quite impossible to see through it. 

It is almost needless to say that any food product containing such 
numbers of living organisms is utterly unfit for use and that to infants 
especially it may be the source of the greatest danger. There seem to 
be three cardinal requirements for good milk aside from perfectly 
healthy cows. These are cleanliness, immediate cooling and rapid de- 
livery to the consumer. To get the best results in regard to milk there 
must be intelligent and free co-operation of the dairymen, the health 
officers and the consumers. 

During the study which was made of conditions at Washington, 
D. C, it was found that 11% of the dairies furnished milk which was 
tubercular to such an extent that guinea pigs quickly died when inocu- 
lated with it, and at least one of the children's homes in Washington 
got its regular supply of milk from one of these dairies. I have noted 
the experience of the Washington investigation only because more care- 
ful study has been made of conditions there than in most other cities. 
Equally careful investigations of other cities might show conditions 
no better. 

Comparatively few animal parasites are transmitted by milk. In 
the Washington investigation no case of animal parasites was dis- 
covered. In the city of Pasadena we probably had a few cases of 
amoebic dysentery indirectly transmitted through milk. 

The chemical analysis of milk in Washington showed that about 
12% of the milk sold in the city was below the standard established 
for butter fat. Milk can easily be pasteurized in the home if any one 
has reason to feel that it may contain either pathogenic bacteria or 
excessive numbers of non-pathogenic bacteria. The pasteurization of 
milk is most easily accomplished by placing the milk in a comparatively 
flat jar or pail and placing this in water raised to a temperature of 
170 degrees. The temperature of the milk should rise to at least 160 
degrees and it should be kept at this temperature for at least a period 



MILK 127 

of twenty minutes and then be rapidly cooled by placing it in ice water. 
Milk treated in this way is changed very little so far as taste is con- 
cerned, and while not all of the bacteria in it are killed, they are greatly 
reduced in numbers and at the low temperature at which the milk should 
be cooled they increase very slowly, and thus the length of time that the 
milk keeps sweet is greatly lengthened. 

It cannot be stated too strongly that the value of pasteurizing is 
wholly dependent upon the prolonged heating of the milk and its rapid 
cooling and maintaining it at a low temperature. 

If these conditions are not observed, pasteurizing may increase 
rather than decrease the bacterial content of milk. 



*MILK. 

There are very few articles of food whose purity and cleanliness 
are more important to us than milk. Under our State law it is declared 
"Milk is the fresh, clean, lacteal secretion obtained by the complete 
milking of one or more healthy cows, properly fed and kept, excluding 
that obtained within fifteen (15) days before, and five (5) days after 
calving, and contains not less than three (3) per cent of milk fat, and 
not less than eight and five-tenths (8.5) per cent of solids not fat." 
With the exception of eggs no single article of food contains the varied 
amount of nourishment which is contained in milk. This fact renders 
milk especially liable to act as the carrier of injurious ferments and 
of bacterial forms of life. In a general way it is safe for us to under- 
stand that any article which is useful to us for food is a substance upon 
which bacteria will readily grow, and thus it may become the medium 
for the introduction of bacteria into our own bodies. There are four 
sources of milk pollution. The first of these is at the place of milking, 
and in the room in which the milk is immediately handled after being 
drawn from the cow. A second opportunity for pollution is during its 
transit to the store or depot from which it is distributed to the stores 
and milkmen. The third is at the store or in the hands of the milk man 
where the milk is kept previous to its delivery to the consumer and the 
fourth and frequently the most dangerous place for pollution is in the 
home of the consumer. If milk is to be clean, as it should be, every 
precaution must be taken from the place of its source until it has 
reached the stomach of the consumer. Cows must not only be healthy, 

*So. Pasadenan, Mar., 1908. 



128 PUBLIC SANITATION AND OTHER PAPERS 

but they must be clean. They should not be permitted to either stand 
in, or drink impure water. The stable should be light and well venti- 
lated and kept scrupulously clean. The milker should wear a special 
dress which is frequently washed. His hands should be clean and dry 
when he begins the milking. All waste matter from the stable should 
be deposited at a considerable distance from where the cows are actually 
kept. The milk should be cooled as soon as possible after it is taken 
from the cows, and it should be put in cans or receptacles which are 
scrupulously clean and which have been subjected to the action of 
boiling water so thoroughly as to destroy all forms of bacterial life 
which might otherwise be present. It is highly desirable that milk 
should pass as rapidly as possible from the producer to the consumer. 
Unless special pains are taken to keep the milk at a low temperature 
the bacteria in milk are subject to an enormous increase in numbers. 
Milk which contains only a few hundred to the drop when it leaves the 
producer may have the number increased to hundreds of thousands in 
twenty-four hours' time if it is kept in a warm place. These bacteria 
are for the most part harmless, but still they continually reduce the 
food value of the milk by using the sugar and proteids for their own 
growth and development. The bacteria which have been found in milk 
may be divided into four groups ; the first group being the common 
bacteria of air, water, and soil. The second group are those forms of 
bacteria commonly found in sewage and in the intestines of people and 
animals. The third group are the bacteria which produce fermenta- 
tion, and the fourth and dangerous group are the pathogenic bacteria 
or the bacteria which produce disease. It is not difficult for us to see 
where the first group of bacteria come from. Small particles of dirt 
on the body of the cow will account for the bacteria of the soil. The 
water used in washing the milk pails will produce large numbers of 
water bacteria, and the air of the average cow stable is heavily charged 
with bacteria which is continually settling into the milk pail. It is prob- 
ably no exaggeration to say that in the ordinary cow stable from five 
to ten thousand bacteria will fall upon each foot of space every minute 
of time. Bacteria of intestinal origin may readily come from the filth 
so frequently found upon the cow. Bacteria of fermentation are very 
abundant in the lower part of the milk ducts of the cow, and the first 
milk obtained from the cow introduces these in large numbers into the 
pail which may afterward be filled with milk. The more important 
bacteria of fermentation are those whose action produces lactic acid 
in milk. This is the most common acid of sour milk. Another acid fre- 



CERTIFIED MILK 129 

quently formed in milk is butyric acid. Alcoholic fermentation occa- 
sionally occurs in milk from some forms of bacteria which may be pres- 
ent. Other forms are capable of coagulating the albuminous part of 
the milk without the milk becoming sour. Still other bacteria produce 
the so-called "disease" of milk and as a result of these diseases milk 
may be either bitter, slimy, or soapy. Occasionally bacteria get into 
milk which cause the milk to change its color, without seriously affect- 
ing the character of the milk. Some of these bacteria produce a red 
milk, others may cause the milk to be yellow or blue. The subject 
of pathogenic bacteria in milk, or those bacteria which produce disease 
among people, is so important that I defer the discussion of these to 
some future time. 



CERTIFIED MILK. 



Certified milk is a comparatively new term in the commercial 
world. The term was first used in describing the milk sold in some 
eastern cities. The standard of certified milk is the highest which it 
is practically possible to attain. In order that milk may properly be 
classed as "certified," the cows from which it is obtained must be sub- 
jected to frequent inspection, and no cow which has the slightest trace 
of tuberculosis must be permitted in the herd. Every cow must be 
carefully washed before she is milked. The milker must not only have 
his hands sterilized, but must be clothed in a newly washed and 
sterilized gown. The milk must be drawn into a sterilized vessel and 
every particle of dust and filth carefully excluded. As soon as pos- 
sible after milking, the milk is placed in sterilized bottles and care- 
fully closed. The bottles are sealed in such a way as to prevent the 
admission of bacteria of any kind and delivered to the consumer in 
these bottles. It is needless to say that milk which receives all the 
attention above mentioned cannot be sold in competition with even 
ordinarily good dairy milk. It is questionable whether adults would 
be specially benefited by using milk of this character, but it is highly 
probable that infant mortality would be decreased if only certified 
milk was used in feeding them. The time is not far distant when 
there will be an opportunity to purchase certified milk in all our towns 
and cities. Everything along the line of better food must be of deep 
interest to all who are striving to better conditions for the preserva- 
tion of public health. 

*So. Pas. Rec, Oct., 1908. 



130 PUBLIC SANITATION AND OTHER PAPERS 



^PRESERVATION OF MILK. 

In a former article I made the statement that the more nearly 
fresh is milk when used, the less likely it is to prove dangerous. It 
occasionally happens, however, that it is absolutely necessary to pre- 
serve milk for some time before using it. When one is confronted by 
such a condition there are two things which may be done : One is to 
sterilize the milk and the other is to Pasteurize it. I do not mention in 
this connection the name of any of the many preservatives which are 
sometimes used in milk, as there is not one which is not highly in- 
jurious. Sterilization of milk may be secured by keeping the milk for 
from thirty to sixty minutes at the temperature of boiling water. Milk 
subjected to this treatment and then securely protected from the air 
will keep almost indefinitely. The objection to this treatment is that 
at the high temperature named the character of the milk undergoes a 
great change. The taste is seriously impaired and it is much less 
digestible. By Pasteurization is meant a process whereby most of the 
bacteria in the milk are destroyed by keeping the milk for some time 
at a temperature destructive to the bacteria but not sufficiently high to 
change the character of the milk. The most desirable temperature for 
this purpose is between 167 degrees and 185 degrees Fahrenheit, or 
between 75 degrees and 85 degrees Centigrade. At this temperature 
almost all forms of bacteria are destroyed. The best way to effect 
the Pasteurization of milk is to set a tin can or pail containing the milk 
in water heated to the temperature suggested and keep it there from 
fifteen to twenty minutes after the milk has been raised to the tem- 
perature of the water. The milk should then be carefully covered 
and cooled as quickly as possible. If it can be passed at once from 
the hot water to the ice chest it is well. Pasteurized milk kept in clean 
dishes and at a low temperature will undergo very little change for 
days. Infant mortality would be greatly reduced if during the sum- 
mer months babes were fed either upon absolutely fresh milk or upon 
milk which has undergone careful Pasteurization. 



So. Pasadenan, April, 1908. 



DISEASES ACQUIRED FROM MILK 131 



*DISEASES WHICH MAY BE ACQUIRED FROM MILK. 

The spread of a considerable number of diseases can be traced 
directly to milk; among those thus spread it is probable that tuber- 
culosis occupies the largest place in the public mind. It is somewhat 
uncertain at the present time as to whether human or bovine tuber- 
culosis is the same disease and whether the form which appears in 
cows can be transmitted to human beings. But until this question is 
definitely settled, it is by far the safer plan to assume that they are 
one and the same disease and that the disease may be readily trans- 
mitted from the infected cow to persons who use the milk from the 
cow. It is quite certain that when a cow is seriously affected by 
tuberculosis, the bacilli may be found not only in the fresh milk but 
also in the skimmed milk, in the butter, and even in the buttermilk, 
and it is more than possible that whoever uses these articles from the 
iiifected cow may acquire the disease. It is certain that bovine tuber- 
culosis is widely disseminated among cattle. In 1901 a careful census 
of cows was taken in England. At that time there were 4,102,000 
cows reported as yielding milk, and of this number at least 80,000 
were found to have well marked indications of being tubercular. It 
is quite probable that the disease is as widely spread in this country. 
There is reason to believe that it becomes especially dangerous when 
the udder of the cow is affected. This is sometimes indicated by the 
swelling of the lymphatic glands immediately in front of the udder. 
There are technical tests which may be applied to the cow which al- 
most positively proves or disproves the presence of this disease. Even 
if the cow from whom the milk is drawn is perfectly healthy, the milk 
may be contaminated by the milker if he, or any members of his fam- 
ily with whom he comes in contact, are tubercular. All of this should 
impress upon us the vital importance of the most rigid milk inspec- 
tion. Typhoid fever is another disease which may be widely spread 
by milk. Not only should no person who has typhoid fever be allowed 
to come near the milk, but it should not be handled in any house in 
which there is a typhoid fever patient. Nor should bottles or other 
receptacles of milk be permitted to be removed from the house of the 
patient suffering from either typhoid fever or any other contagious 
disease. While it is not certain that diphtheria is spread by water, it 
is very certain that it may be spread by means of milk. Cows them- 

*So. Pasadenan, April, 1908. 



132 PUBLIC SANITATION AND OTHER PAPERS 

selves may have the disease in a mild form and without being seriously- 
sick may become the means of widely spreading the disease. Milkers, 
or those with whom milkers come in contact, may become the means 
cf infecting the milk. All that is said of diphtheria may be said with 
equal force of scarlet fever. Aside from these most dangerous dis- 
eases, thrush, sore throat, and diarrhoeas may frequently be traced to 
the milk supply. All of these may come from cows which give no 
indication of disease, and frequently where cows are perfectly healthy 
the source of infection is found to be in the milker, or in some mem- 
ber of his family. All of this emphasizes the supreme importance of 
cleanliness in handling milk and all milk products. Many infectious 
diseases would be avoided if only fresh milk were used. Another 
source of infection of milk is found in the dirty and easily con- 
trolled house-fly. The time is not far distant when in enlightened 
and cleanly communities this insect will be effectually banished. It is 
not unusual for people to read notes of warning of this kind and smile 
over the affair and wonder why it is that we are endangered so much 
more than were our grandfathers, who knew nothing of bacteria. The 
reply to an objection of this kind is that if we wish to live as they 
lived we must die as they died, and it is proper to remember that mod- 
ern hygiene, public and private, has probably doubled the average 
length of human life within the last twenty-five years, largely by re- 
ducing infant mortality. No page of human history is sadder than 
the statistics of the death rate of infants in our large cities in the near 
past from causes easily controlled by proper attention to public and 
private hygiene. 



More and more we are coming to learn the great truth that proper 
care of the body demands the proper mental attitude on the part of 
the patient, and the proper mental attitude can only be maintained by 
those who are engaged in useful work. The old Jewish myth that 
work was imposed upon man as a punishment is not good. It is only 
by work that man can express himself, and thus come to his highest 
development. The basis of good health lies in the common sense life 
of active, energetic usefulness. 



ICE CREAM 133 



*ICE CREAM. 

Years ago ice cream was regarded as a luxury to be served out 
to people in small quantities on the Fourth of July, and occasionally 
at some church social, but of late it has assumed a position of con- 
siderable importance in every-day life, and is widely prescribed by 
doctors for invalids and children. 

Its real value as a food product is a matter of some doubt. It 
is very certain that while it has considerable food value, its use in large 
quantities is not conducive to the activity of the stomach. If it is 
swallowed before it has become thoroughly melted and warmed it must 
exert something of a depressing influence upon stomach conditions, 
and may not only be slow of digestion, but may seriously delay the 
digestion of other articles of food. If it is to be used at all it is cer- 
tainly of the utmost importance to have its constituents good, and our 
pure food law requires that the constituents shall not only be good, but 
that any article labeled ice cream shall conform to certain standards. 

Both gelatin and starch are extensively used in thickening ice 
cream. Various coal tar dyes have been used for desirable colors. 

In the District of Columbia a local ordinance requires that it shall 
contain not less than 20 per cent butter fat. A short time ago a care- 
ful bacteriological analysis was made of the product as sold in the city 
of Washington. As a result of this investigation, it was found that no 
cream on the market contained less than one million bacteria per cubic 
centimeter, and that from this the number ranged up to one hundred 
million bacteria per cubic centimeter. The average was about three 
and one-half millions per cubic centimeter. The danger of any food 
from a bacteriological standpoint depends much more upon the char- 
acter of the bacteria than upon their number. From the figures given 
it will be seen that a freezing temperature is by no means incompatible 
with bacterial life. Many of the bacteria found in ice cream are un- 
doubtedly to be found in the products entering into its composition, 
but it is quite likely that the ordinary ice cream freezer contains such 
numbers of them that the number found in the product will be ma- 
terially increased by contact with the freezer. 

In several of the cities of Great Britain such serious sickness has 
been traced to ice cream that cities have enacted special ordinances 

*West. Ost., Jan., 1911. 



134 PUBLIC SANITATION AND OTHER PAPERS 

governing its manufacture and sale. The regulations of London, Glas- 
gow, and Liverpool are substantially the same. These provide that: 

(1.) Ice cream must be made and stored in thoroughly sanitary 
places. 

(2.) It must not be made or stored in living rooms, no matter 
how clean nor how well ventilated. 

(3.) Strict precautions must be taken to prevent all contamina- 
tion. 

(4.) All cases of infectious disease among those who use the ice 
cream must be immediately reported. 

(5.) The name and address of the maker of the ice cream must 
appear upon every package. 

Many careful health authorities seriously question the value of 
pasteurizing the milk or cream used in making ice cream, but it is be- 
lieved by some that when the raw material has been properly pasteur- 
ized there is somewhat less danger of tyrotoxicon forming in the ice 
cream. No matter how favorably we may feel toward ice cream when 
properly made and properly kept until it is sold, we cannot help feeling 
that ice cream as it is sold at the corner grocery and on the street is 
a rather dangerous kind of food, and it is highly probable that a reas- 
onable regulation of the process of manufacturing ice cream and regu- 
lations which will prevent its contamination until it is sold will go far 
toward relieving children from its dangers. 



*THE OYSTER. 



As the oyster season is now upon us, a few words in regard to the 
dangers of these delicious bivalves may not be entirely out of place. 

As early as 1816, Pasquier, a French physician, noticed that there 
was some relationship between the use of oysters and typhoid fever. 
His observation of facts was correct; but, not unnaturally, his ex- 
planation of these facts bore little resemblance to what we now regard 
as the truth. After the observations of Pasquier, the whole question 
of the relationship of oysters to typhoid fever lapsed, until it was re- 
vived by the English physician, Cameron, in 1880. From this time on, 
numerous observations were made which tended to show, more and 



*Jour. A. O. A., Sept., 1912. 



THE OYSTER 135 

more positively, the fact that a close relationship exists between cer- 
tain outbreaks of typhoid fever and the use of oysters. 

The matter was most completely traced out in this country in 
1894, when there was an outbreak of typhoid fever among the students 
of Wesleyan University, Connecticut. This epidemic was investigated 
by Prof. W. H. Conn. At that time there were seven fraternities in 
the University; of these three indulged in the liberal use of oysters, 
and in these three fraternities, twenty-three cases of typhoid fever de- 
veloped. At the same time, it was noted that the students of Amherst 
College who used oysters also developed numerous cases of the same 
disease. In the investigations made by Prof. Conn, it was found that 
the oysters used by both colleges were obtained from water which was 
more or less contaminated by sewage. 

As a result of Prof. Conn's investigation, it was found that the 
typhoid bacilli may live for a period of at least eighteen days in the 
gills and alimentary tract of the oyster. He also found that the typhoid 
bacilli may live in sea water for a period of from three to five weeks, 
and that in cockles, the typhoid bacilli may live indefinitely and multiply. 

Sewage is not the only way in which these mollusks may become 
infected. It is to be remembered that there is a possibility of their be- 
coming infected from the hands of those who pack them and from the 
various processes which they may undergo while being prepared for 
shipment. Dr. Boyce, of England, recently made a careful investiga- 
tion of 140 oysters, taken from the open market, and he found that of 
this number 104 were infected with the bacillus coli. It is needless to 
say that if the sewage from which these were infected had contained 
the bacillus typhosus, they might equally as well have been infected by 
this extremely dangerous organism. 

As cities multiply along the sea coast, and upon rivers discharging 
into the ocean, and as they increase in size, the possibility of infection 
continually increases, and public safety will more and more demand 
the careful inspection of oyster beds. In tracing the history of typhoid 
fever cases, the physician should not fail to recognize the possibility 
of oysters being the source of infection. 



One part of the price we pay for increasing knowledge is an in- 
creased appreciation of the vast amount of unexplored territory that 
lies all about us. 



136 PUBLIC SANITATION AND OTHER PAPERS 



*HEALTH NOTES. 

Health is natural, — disease is unnatural, and it always comes as 
the direct or indirect result of wrong living. Sometimes this wrong 
living has been by parents, or even further back than that; but the 
greater part of ill health and disease comes from wrong living on the 
part of the individual. 

We are living in an age of bargain hunters, — we all want some- 
thing for nothing. We want to live regardless of the laws of our 
being, and then we want the doctor to give us some kind of a pill, or 
some kind of a "treatment" which will make us as we would have been 
had we lived sane and proper lives. Fortunately or unfortunately the 
doctor is unable to give either pills or treatment which will accomplish 
the results which we want. Medicines and "treatments" of various 
kinds may more or less obscure symptoms, but they can never take 
the place of right living. Moreover we must learn that there is no such 
thing as a "cure," in the sense that recovery comes from conditions 
outside of the body. By way of illustration let me say that if the 
victim of a broken bone could avail himself of the combined wisdom of 
all the doctors and surgeons in the world, their combined wisdom 
would not be able to effect a "cure," — all that they could do would be 
to properly adjust the broken bones to each other, and hold them in 
place in such a way as to least interfere with circulation, and then in- 
struct the patient in regard to personal hygiene. If the bones should 
ever unite with each other, it would be from causes which are internal 
to the body of the patient. This perfectly obvious statement is just 
as true in regard to the more obscure diseases, as it is in purely surgi- 
cal cases, — in every case the source of recovery is inherent in the body 
of the patient, and in order that this source may be at its best the 
patient must live a hygienic life. 

No tonics or stimulants can ever take the place of proper hours and 
sane hygienic living. When people at large shall fully realize the truth 
of this, and that the matter of health is largely in their own hands, it 
will produce a healthy and normal sense of responsibility, which will 
go far toward keeping them from doing foolish and unreasonable 
things. It seems impossible to impress too strongly upon every indi- 
vidual the great fact of his own responsibility, that there is no such 

*So. Pas. Rec, Dec, 1912. 



HIGH HEELED SHOES 137 

thing as anyone doing for us anything which is of very much advan- 
tage to us. 

If people are going to be moral and are going to be of value to 
themselves and to others, it must be through no hocus pocus of imputed 
righteousness, but through a deep conviction on the part of the indivi- 
dual of his moral responsibility, and if he is going to be well, he must 
rely upon a strict and careful observance of the laws of health, rather 
than upon anything which even the wisest physician can do for him. 



-HIGH HEELED SHOES. 



A visit to any of the large shoe stores is enough to convince one 
who has a knowledge of the structure of the human body that the 
shoes which are most in demand are extremely destructive to health. 
A prominent shoe dealer in Los Angeles, with whom I had conversa- 
tion a few days ago, told me he felt sure that less than 1 per cent of 
the women who came to his store purchased shoes in which heels and 
general shape were in harmony with the requirements of the human 
foot. 

The modern shoe demanded by fashion is not only destructive to the 
foot, but is almost certain to produce physical conditions of the body 
which are incompatible with good health. We marvel at the absurd 
customs of the Chinese women in bringing about the deformity of the 
foot, but so far as general health is concerned one would better bind the 
foot in harmony with the Chinese custom than to wear the modern 
American shoe. The Chinese custom was undoubtedly destructive to 
the feet, but it produced little effect upon the general health; whereas 
our modern shoes are laying the foundation for prolonged invalidism. 

If people would wear reasonable clothing throughout, live upon a 
simple diet, sleep in well ventilated rooms, and insist upon good public 
sanitation and avoid late hours, three-fourths of the doctors in the land 
would be trying to find something to do. Most of the ills from which 
we suffer are those we bring upon ourselves, either by our excesses or 
by dictates of fashion. 



Whatever its physical explanation may be, daydreaming is a most 
injurious habit, and should be checked by everyone who desires to pre- 
serve the power of healthy and vigorous thought. 



So. Pas. Rec, June, 1909. 



138 PUBLIC SANITATION AND OTHER PAPERS 



*HOW SICK PEOPLE GET WELL. 

A very clear article on "How People Get Sick" was presented in 
these columns last week. This week I wish to present some thoughts 
as to how people recover their health when they are really sick. Sickness 
always represents an abnormal condition of the body, and as a general 
thing an abnormal condition of the mind accompanies this. By an 
abnormal condition is meant a swinging away or moving away from 
the normal or usual condition ; and, fortunately for us, there is a strong 
tendency on the part of all organized beings to swing back to the normal 
condition when for any reason the organism shall have passed into an 
abnormal condition. This may be not inaptly compared to the tendency 
of a pendulum to swing back to the middle point, when it is carried away 
from this in either direction. This tendency to return to a normal con- 
dition is so strong that in the great majority of cases persons who have 
not passed the meridian of life will eventually swing back into normal 
condition, whether they do or do not have medical attention. 

The tendency to return to the normal condition may be prevented 
by a number of physical conditions, as well as by some mental condi- 
tions. For instance, some bone may be more or less displaced or sub- 
luxated, as it is technically called. This displacement of the bone may be 
of such a character that it will not return to its normal condition with- 
out artificial aid; and the displacement may not only result in local in- 
convenience, but may bring about a general disturbance of the entire 
system. It is not very unusual for some of the vertebrae which form the 
spinal column to become somewhat displaced. Not only is there a certain 
amount of local soreness produced by this, but the entire system may be 
disturbed by the pressure which these displaced or sub-luxated bones 
exert. What is true of a subluxated bone in this region is also true of 
subluxated bones in many other parts of the body. Anything 
which prevents a free return of the blood to the heart may result in 
disorder. Thus, bandages, or tight clothing of any kind, may act just 
as contracted muscles act to render the return of the blood to the heart 
difficult, thus causing it to unduly accumulate in the veins until the 
walls of the veins become ruptured or very greatly stretched. 

The life of the body consists of the sum of the activities of the 
cells of which the body is composed. Anything which interferes with 

*So. Pasadenan, Sept., 1903. 



HOW SICK PEOPLE GET WELL 139 

the normal action of the cell of course interferes to just that extent 
with the normal action of the whole ; and anything which prevents the 
cells from freely receiving their nourishment, and from being normally 
stimulated by nerve action interferes with their functional activity. 

There is little danger of our over estimating the influence of the 
mind upon bodily function, providing we bring to bear in our inves- 
tigations along this line the result of careful and accurate observations. 
This being true, it follows that we must regard the mental attitude of the 
patient as an important factor in his recovery from disease. If the 
patient is of cheerful disposition, full of interest in life, with faith in his 
physician and in himself, his recovery is very much easier than when 
some or all of these elements are lacking. 

More than forty years ago Dr. Oliver Wendell Holmes expressed 
the opinion that by far the largest number of diseases which physicians 
are called to treat will get well at any rate, even in spite of moderately 
bad treatment. That of the other fraction, a certain number will inevit- 
ably die, whatever is done. That there remains a small margin of cases 
where the life of the patient depends upon the skill of the physician. 

Whatever the disease may be, or whatever system of treatment is 
employed, the first requisite for a return to health is for the patient to 
live in a strictly hygienic manner. This means fresh air and plenty of it. 
The sleeping room must be thoroughly ventilated. The patient should 
drink freely of pure water. The less a patient eats, the better off he is 
likely to be. There is little danger of a sick person's "losing strength" 
from not eating. There is much more danger of his suffering from 
digestive troubles caused by overeating. 

Doctors do not "cure" the sick. They get well because of the ten- 
dency to return to normal conditions already mentioned, and this ten- 
dency may be strengthened to a greater or less degree by the care and 
advice of a competent physician. 



There is a broad selfishness that closely touches the broadest 
generosity. For when one thoroughly understands the root of his own 
best good and greatest happiness, he finds it to grow from the things 
which make for the best good of the community in which he lives, and 
of the people with whom he is associated. 



140 PUBLIC SANITATION AND OTHER PAPERS 



*THE STATE AND THE INDIVIDUAL. 

Responsibility must ever be measured by opportunity and the lan- 
guage of good works is the truest expression of gratitude. The respon- 
sibility of the individual is two fold. First, he is so closely linked to 
other members of society that his failure to discharge his obligations 
aright necessarily hinders others in the performance of their duties and 
his success is greatest when it most helps others to succeed. Second, 
and most important, is the duty of the individual to posterity. We are 
the heirs of all the ages, and only life tenants of the earth. Our most 
solemn duty is to conserve our heritage and transmit it, somewhat aug- 
mented, to those who are to follow. Our advantages are founded upon 
the self-sacrifice and courage and devotion of those who have preceded 
us, and we can only show ourselves worthy of this rich heritage by 
carrying it as long as we can, adding to it while we may and deliver- 
ing it into the hands of those who are to follow us. 

This can only be done by men and women with sound bodies, and 
health can only be maintained by those who avoid all excesses. Not only 
must w r e avoid the excesses which are commonly recognized as evil, but 
also those which usually escape attention. Late hours, over-eating, im- 
perfectly ventilated rooms are all incompatible with the life of a person 
who would constantly live up to his best. It is more important for us to 
keep well than it to get well. A knowledge of hygiene is worth more to 
us than a knowledge of medicine. It is impossible for us to separate 
the intellectual nature from the moral nature. The good man is one who 
knows what is good as well as one who is willing to do what is good. 
It was said of old that as a man thinketh in his heart, so is he, and no 
one can think aright without a proper intellectual foundation. 

There is an important time in one's life, a time which comes usually 
between 12 or 13 years of age and the early 20's, when the nervous sys- 
tem is undergoing rapid development. It is at this time that the nerve 
cells are coming into new and remarkably complex relationship with each 
other; a time when paths of action are being developed in the central 
nervous system ; a time when the individual responds most keenly to all 
external stimulation ; a time of all others when he should be kept from 
all unnatural and irrational excitement. At this time in his life 
every emotion should express itself in action. There is no time in 
life so favorable as this time for inculcating in the individual a real love 
for the truth and the habit of being doers and not mere hearers. The 
only thing we need fear is the consciousness of not having done our best. 

*Thanksgiving Address, South Pasadena, Nov., 1903. From So. Pasadenan. 



USEFUL VS. USELESS INDUSTRY 141 



^USEFUL VS. USELESS INDUSTRY. 

It is a common mistake to assume that because an industry re- 
quires a large outlay of capital, and because it employs many laborers 
it is necessarily beneficial to the community and to the nation at large. 
As a matter of fact any industry is to be judged by the same standard 
which we would apply to an individual, namely, its results. If millions 
of money and scores of laborers are employed in the development of an 
industry whose results are valueless, that industry as a whole is detri- 
mental to society, and the greater the amount of capital employed and 
the greater the pay-roll of the employes the greater is the harm which 
results from it. A good many people and a good many newspapers 
that should clearly recognize the truth of the foregoing statement are 
objecting to any restriction being placed upon the production of Cali- 
fornia wine because of the great amount of capital involved in its pro- 
duction, and because of the large numbers of men employed in pro- 
ducing it. 

As I have already stated, these facts have nothing whatever to do 
with the merits of the question. If California wine, or any other wine, 
is necessary for our people, or if in any way whatever it materially aids 
in our advancement, then of course whoever produces it is contributing 
to the welfare of the state, but if its effects are upon the whole injurious, 
and if society in general would be better off without it, then instead of 
the great amount of capital invested and the great number of men em- 
ployed being an argument in its favor it is one of the strongest possible 
arguments against its use and in favor of all rational restriction. 

If some insane capitalist should gather machinery and men for the 
purpose of heaping up sand on the seashore, we certainly would not 
feel that he was aiding in the slightest degree to the wealth of the state, 
although he might invest large sums of money in machinery and his 
payroll might show that he was distributing large sums of money every 
week or every month. However evident it would be to us that industry 
of this kind is wholly non-productive, it would not, on the other hand, 
be particularly harmful, and the worst that we could say of it is that 
it is a complete waste of the time and energy of the men directly and 
indirectly employed in furthering this industry. But if he should em- 
ploy his machinery and men in spreading the sand upon our highways 
we would readily say that not only is his industry useless, but that it is 
absolutely harmful to the community. 

If it is true that wine lessens the efficiency of the human race, then 

*So. Pas. Kec, Nov., 1913. 



142 PUBLIC SANITATION AND OTHER PAPERS 

it is true that every acre of land upon which grapes are raised for the 
purpose of producing wine, every laborer employed directly or indirectly 
in its production is not only a waste of the land and of the time and 
energy of the laborer, but that both are worse than useless to the extent 
that the wine produced lessens the proficiency of the citizens of the state. 
If it is true that the use of the wine is deleterious, then it is true that 
the state would be far better off if the land used in producing grapes 
should be allowed to relapse into wilderness and the state could far 
better afford to pension the men engaged in the wine industry and have 
them live in absolute idleness rather than have them engage in work 
the results of which are disastrous to the community. 

One reason why the fertile slopes of the Atlantic seaboard are not 
more useful to us is because of the great tobacco industry. Tens of 
thousands of acres of land which might produce useful foodstuffs and 
clothing, land which might be producing magnificent forest timber, is 
now employed in the production of tobacco. Thousands of men whose 
labor might be employed in producing those things which would add 
to the comfort and safety of society are now engaged in producing that 
which is, to draw it mildly, useless. 

I am not, at the present time, entering into any discussion as to 
whether wine and tobacco are useful or necessary or not useful and 
necessary, but I do desire to call attention very clearly to the proposi- 
tion that no industry has any claim upon us simply because it gives em- 
ployment to laborers. Before any industry can have any claims upon 
us whatever, it must be shown not only that it represents the investment 
of capital and the employment of labor, but that the products of the 
industry are beneficial. 



It is possible, perhaps, to class the results of nerve cell action into 
two groups : emotions and actions. The former are primarily of use 
to the individual, and affect the outside world only as they stimulate 
motor centers and thus become changed into the second group. It may 
not be out of place to express my personal opinion that any excitation 
of emotion which does not find expression in action is injurious to the 
person thus excited, and that this is especially true in the case of young 
people. 



YOUNG PEOPLE AND TOBACCO 143 



*YOUNG PEOPLE AND TOBACCO. 

Our public schools and our high schools have resumed their work 
for a new year and there is a widespread feeling, not only on the part 
of parents and patrons, but on the part of the public in general, that 
students should be held to the highest standards in their work. 

If this is going to be done, it means that students must be in the 
best physical condition, and this can only be when they live sane and 
normal lives. During the high school stage of development, both boys 
and girls are subject to an unusual number of temptations ; this is due 
in part to the fact that they begin to assume some personal independ- 
ence, at a time when they have had very little experience in life to 
guide them. But it is also due in part to the fact that the nervous sys- 
tem is at this time of life, in a particularly upset and chaotic condition. 
It is during this period of life that they pass from the condition 
which characterizes the child to the condition which characterizes the 
adult. With the nervous system naturally in this unstable condition, we 
need not be surprised that the boy or girl is particularly sensitive to 
anything which may act as an irritant. 

If children are to pass from this stage into a healthy and vigorous 
young manhood and young womanhood they must not be deprived of 
the necessary amount of sleep. During this period of their lives, eve- 
ning parties with their artificial excitement and the character of food 
which is usually served, are particularly out of place. It is perfectly 
proper for young people passing through this stage of development 
to have social amusements, but it would be much better if all social 
functions could take place during the daylight rather than during the 
first half of the night. 

Whatever we may think of tobacco for the adult, the fact remains 
that it is terribly destructive to the undeveloped, growing boy. Person- 
ally I believe the effects of tobacco at this time of life to be worse than 
the moderate use of alcoholic liquors. For not only does it upset the 
nervous system and digestion, but it breaks down the finer sensibili- 
ties, and in that way is destructive to the moral fibre. No human being 
should willingly fetter himself with a habit of any kind. There is 
probably not one habit connected with the nutrition of the body which 
is not more or less injurious. I have no intention at this time to dis- 
cuss tobacco from an economic standpoint, but I do earnestly feel that 

*So. Pas. Rec, Oct., 1912. 



144 PUBLIC SANITATION AND OTHER PAPERS 

boys who become habituated to its use are carrying a handicap which 
will seriously interfere with the success in life which otherwise might 
come to them. 

No kind of tobacco is more dangerous than that used in the 
cigarette, and unfortunately, this is the form of tobacco most popular 
with boys. Educators and physicians all over the world are calling 
attention to the appalling effects of tobacco on the growing boy and are 
pointing to the fact that he is inferior in every respect to the boy free 
from this habit. 

There is good reason to believe that the evil does not end with the 
generation acquiring the habit. The descendants of those who have 
injured their nervous systems in youth by drugs of any kind are never 
as healthy and vigorous as are those who come from a stronger ancestry. 
The ranks of the neurasthenics, the incompetents, the inefficients 
of all kinds are largely filled by the offspring of parents who failed to lay 
the foundation of a well developed nervous system in youth. If 
these views be true, and the best thinkers and closest observers 
believe them to be true, then we owe it as a duty not only to the present 
generation but to the future, to do our utmost to root out a habit so 
injurious. 

The united efforts of parents and teachers can go far, not only to- 
ward helping those not too deeply in the toils to break the habit, but 
what is even more important, to keep others from becoming the victims 
of a habit which has nothing to commend it, and everything to con- 
demn it. 



No person is safe, either physically, mentally, or morally, so long 
as he consciously directs the important issues of life. Safety comes 
only when one has decided the question correctly so many times that 
the unconscious centers have become habituated to act in the right way, 
and they do so without direction from the conscious centers. 

The training for life should educate the subconscious centers to act 
in the right way, so that when one is suddenly called upon to act he 
will unconsciously choose the right. When the subconscious centers 
are thoroughly trained one seems to be deprived of the power of choice. 
And it is then only that one can be truly safe. There is no such thing 
as being "safe from temptation." To be "safe" there must be no temp- 
tation. And we may well barter the power of choice for the certainty 
of rectitude. 



LATE HOURS 145 



*LATE HOURS. 

We are as a people too much given to having evening entertain- 
ments. If this is bad for the adult, as I certainly believe it is, it is 
little short of destruction to children, and especially to boys and girls 
at the High School age. Every period of our lives from birth to death 
may properly be regarded as a critical period, but some of the stages 
through which we pass are much more critical than others. This is 
especially true during the period of adolesence, or that time in life ex- 
tending from the early teens to the early twenties, when the individual 
is changing from childhood to manhood or womanhood. Every part 
of the body at this time is deeply affected. The growth is, as we know, 
particularly rapid. The cells of the body are dividing at so rapid a 
rate that a description of their reproductive powers would hardly be 
credited. This means a terrible drain upon the vital energies of the 
body. When it is remembered that the child not only has to meet this 
demand upon his system, but also to provide for the ordinary activities 
of the body as expressed in his daily play and work, it is easy to see 
that when there is added to this inevitable strain that of the loss of 
sleep and unnatural excitement there is serious danger of over taxation 
which will result disastrously. 

Not only is rapid growth taking place, as before stated, but the 
entire nervous system is in a singularly chaotic state. New combina- 
tions of nerve cells are continually taking place and enormous numbers 
of cells which have lain dormant during his entire life up to this period 
now spring into most rapid development. If proper nervous combi- 
nations are to be made the child must at this time of life be saved from 
all unnatural and abnormal excitements. Eoss of sleep and unnatural 
excitement during this formative period in life are manifested later in 
life in the form of hysteria, neurasthenia and general mental debility. 

If boys and girls are to grow into strong, sane, well-balanced, cool- 
headed men and women, they must at this formative period have plenty 
of nutritious food and plenty of sleep, the latter in thoroughly ventilated 
bedrooms, or better still, in the open air. The number of alcohol users 
and of drug fiends in general would be in my judgment greatly dimin- 
ished if boys and girls grew up with sound, well-developed bodies. 
In perhaps a majority of cases the man or woman is driven to the use 

*So. Pas. Rec, April, 1909. 



146 PUBLIC SANITATION AND OTHER PAPERS 

of stimulating drugs or drinks by a feeling of weakness which comes 
from an imperfectly developed nervous system. 

To make my meaning perfectly clear I will briefly say that I believe 
that all entertainments for young people, and entertainments in which 
they participate, should be concluded by or before early supper time, 
and that if parents would rigidly insist upon children not attending ex- 
citing entertainments of any kind, and upon their being in bed not later 
than 8 :30 or 9 o'clock every night, we would give to the next generation 
a far better class of people than we at present have, and that criminality 
of all kinds would be greatly diminished. 

The High School age is pre-eminently the age in which to impress 
upon the child a deep conviction of his duty and responsibility as a 
member of society, and the less his attention is called at this period of 
life to rewards, either here or hereafter, for probity and honesty and 
all that goes to make up true manhood, the deeper is likely to be the 
real moral worth of his character. 



In our public schools we manage to teach almost everything ex- 
cept the most important thing which all of us should know, and that is 
how to care for ourselves in such a way that we can best meet and dis- 
charge the obligations which life imposes upon us. 

The word "doctor" originally meant teacher. The physician of 
the future will be the doctor who will give his patient instruction which 
will make it possible for him to dispense with the services of a doctor. 
When the doctor attends the same patient for acute disease over and 
over again it is evident that there is a wrong somewhere. Surely the 
doctor does not properly teach his patient how to keep well, or the 
patient does not learn his lesson. 

In our city, and all other cities, too much attention cannot be given 
to public hygiene. Our freedom from disease is due to our reasonably 
good water, reasonably good household sanitation, and I believe espec- 
ially to our well oiled streets, which are largely free from dust, and 
numerous unoccupied lots. The latter condition will change as our 
city becomes more populous and houses are built closer together, and 
if we are still to preserve our reputation for healthfulness it must be 
because public hygiene keeps pace with the increase of population. 
This can be done only with the intelligent co-operation of our citizens. 



VENTILATION 147 



^VENTILATION. 

Dr. W. A. Evans, commissioner of Health, of Chicago, recently 
delivered a lecture on Ventilation in Schools. Much of his lecture 
applies quite as much to offices and other places of assemblage as to 
schools. In this lecture he called attention to the fact that good air and 
sunlight are necessary for health and vigor during the entire life, but 
that the need of this is especially strong during the school period of 
life. There are tremendous changes which take place in the body be- 
tween the ages of ten and twenty, and if, during this time, the health 
of the child is allowed to sink very far below par, it is difficult for him to 
fully recover later in life. It is during this time that many of the habits 
of life are established, and the eye and other organs of the body are as- 
suming a permanent shape. If the child during this time is under 
serious strain of eye or brain, he may not immediately show the effect, 
but at a later time in life he is almost certain to suffer seriously. 

Many schools and offices are heated by hot air and in many cases 
the air thus heated is too dry for health. In many public buildings it is 
assumed that if from twelve to eighteen hundred feet of air for each 
person is pumped into the room, the ventilation is good. This does not 
necessarily follow unless the size of the room is such that each person 
has from four to six hundred cubic feet of air space. Then, too, it often 
happens that where the initial air volume and where the amount supplied 
each hour is all that can be desired, the air is too dry. Where this is 
the case children as well as adults are likely to suffer from colds and 
from large glands and tonsils. It also encourages mouth breathing, and 
children become pale, flabby, nervous and frequent sufferers from head- 
aches. 

The ideal school room of the present time is narrow ; indeed, some 
architects advise that it should not be wider than twice the distance from 
the top of the window to the floor, and experience is showing that ex- 
tensive height in the room is not good. It is highly probable that a room 
nine feet in height is better, all things considered, than one that is twelve 
or fifteen feet in height. 

The evils which come from imperfect ventilation can be divided into 
two general groups : The first group includes the infections which 
come from breathing air polluted with bacteria, and the other group in- 
cludes the evils which come from the condition of the air itself. Among 
the diseases which probably come from the air may be mentioned in- 

*West. Ost., Dec, 1911. 



148 PUBLIC SANITATION AND OTHER PAPERS 

fluenza, common colds, cerebral spinal meningitis, anterior poliomye- 
litis. In all these diseases the bacteria are undoubtedly transported 
considerable distances. The bacilli of pneumonia and tuberculosis 
probably cannot be carried any considerable distance by the air. 
Bad ventilation in and of itself produces drowsiness, headache, 
lassitude and sometimes far reaching effects upon the system, in- 
cluding anemia, chlorosis, chorea and more or less mental degeneration. 
Many unsuccessful efforts have been made to discover patho- 
genic bacteria in the air. These efforts by no means prove the absence 
of the bacteria. Time and again it has been found impossible to isolate 
pathogenic bacteria from water and from milk which are positively 
known to be in condition to carry disease. Experiments have been 
made by filling the mouth with harmless bacteria and then determining 
to what distance they may be carried, where the air is quiet. These 
experiments have demonstrated that twenty feet is about the greatest 
distance to which bacteria may be carried in quiet air. Some experi- 
ments have shown that where a person is breathing quietly in a close 
room that the air immediately surrounding the body is somewhat freer 
from bacteria than is the other air in the room. This is due to the fact 
that the bacteria which are inhaled are for the most part retained in 
the respiratory passages of the body. In all cases where it is possible, 
water should be evaporated in rooms heated by hot air. Windows 
should be frequently raised and air from the outside allowed to cir- 
culate through the room. Every effort should be made to diminish 
the amount of dust which is found in the air. The regulation of light 
is frequently afforded much better where curtains roll up from the 
bottom of the window than where they are dropped from the 
top. Of course, many of these details involve some time and some- 
times the expenditure of money, but time and money that are expended 
for the development of health is a good investment. Every generation 
should try to do all in its power to make conditions better for the gen- 
eration which is to follow, and they can leave them no better inheritance 
than healthy, vigorous bodies. 






It is a matter of minor importance to decide who is right ; the thing 
which concerns us is to decide what is right, — that is, what is true. 
The truth is the thing to search for; whether one or another found it 
is an extremely small matter. 



PLAY GROUNDS FOR CHILDREN 149 



*PLAY GROUNDS FOR CHILDREN. 

While I was in Minneapolis attending the National Osteopathic 
Association last summer, I stole away from some of the interesting 
sessions to visit points of interest both in Minneapolis and St. Paul. 

Of the many things which impressed me, nothing seemed to me of 
more far-reaching importance than did the play grounds in the City 
of St Paul. These playgrounds are in several different parts of the 
city, the largest and most extensive being on Harriet Island in the 
Mississippi River. All of these playgrounds are managed for the direct 
benefit of children, and their purpose is not only to aid in the physical 
development of the child, but also to aid in cultivating his moral nature, 
his patriotism, and to fit him for the high duties of American citizen- 
ship. These, several ends are accomplished by providing the playgrounds 
with simple and strong apparatus, and by having the buildings sub- 
stantial and attractive, and by employing policemen who are teachers 
rather than the conventional "guardians of the peace." 

As our civilization becomes more complex, the task of developing 
healthy and useful men and women continually becomes more difficult. 
It is recognized by all thoughtful people that play has an important part 
in all normal development, and in order that play may be most effective, 
there must be suitable grounds and surroundings. 

The great importance of proper development is not understood 
by the people at large, and among all of the various classes of public 
teachers, none are more fitted to impress this upon the public than are 
the physicians. Not only must the people at large be educated to recog- 
nize play and physical recreation as absolutely necessary for the child, 
but people must be educated to understand the necessity for careful 
physical examinations being made, which shall recognize all kinds of 
physical defects. In the St. Paul system the children are watched by 
teachers and physicians while at their play, and if they give evidence of 
any marked deficiency they are carefully studied, and every effort is 
made to enable them to overcome the defects. It is undoubtedly well 
to establish reformatory institutions of various kinds ; it is well to help 
the criminal into a better life; but it is far more important to prevent 
the development of the criminal than it is to reform him after his 
criminal habits have been formed. 



*West. Ost., Oct., 1909. 



150 PUBLIC SANITATION AND OTHER PAPERS 

In the civilization of the future we shall pay much more atten- 
tion to the prevention of poverty and crime and all that is bad than to 
the reclamation of those who have fallen by the wayside. Now is the 
time in our California towns, as well as in other towns, to secure ample 
commons, and play grounds for the future. However, expensive land 
may be in the present time, we may feel quite sure that it will not be 
cheaper in the future, and when land has once been occupied by build- 
ings, it is no easy matter to secure it for public purposes. In all of 
our towns ample playgrounds should be provided — grounds that are 
not only large enough for the present needs, but which will 
be ample for the increased population of the future. Dollars spent in 
this way will go far towards obviating the spending of tens of dollars 
in the future for criminal courts and prisons. The growing boy who 
thoroughly enjoys hearty, active play is much less likely to develop 
criminal tendencies than is the boy who because of lack of opportunity 
for play, hangs around the corner grocery or loiters on the street 
corners. 

Osteopathic physicians probably are making a closer study of the 
human body and its needs than any other class of physicians. If this 
be true, they should understand better than others the necessity for 
proper places of recreation, and they should be the leaders in the com- 
munity for securing a place of this kind. 



*SCHOOL ARCHITECTURE. 

Edward Hyatt, Superintendent of Public Schools of California, 
has just issued a book on "School Architecture" which is of very much 
more than passing importance. The book deals not only with school 
architecture, but also with the problems concerned with play grounds, 
school gardens, school heating, and in fact almost everything material 
concerning the care and training of children. The book should be 
carefully studied not only by school boards and teachers, but also by 
parents who would intelligently co-operate with teachers in the great 
work of properly training and developing the coming generation. 

It is needless to tell the American people of the superlative value 
of public schools, but it is quite necessary to attempt to educate the 
public in regard to the dangers connected with our school system. 
While the schools are unquestionably efficient in producing intelligent 

*So. Pas. Rec, April, 1910. 



SCHOOL ARCHITECTURE 151 

citizens, it is very often in the school that the future citizen lays a 
foundation for ill health which not only shortens his life, but greatly 
impairs his usefulness while he lives. The ill-ventilated schoolroom of 
the past, the free exchange of lunches among children, the common 
drinking cup, the common towel, the bad toilet arrangements combined 
to make easy the spread of tuberculosis and other contagious diseases. 
The unfortunate arrangement of windows permitted light to enter 
which made study possible, but it often entered in such a way as to 
seriously impair the eyesight of the child. Where poor ventilation did 
not actually lead to contracting disease, it often lowered the vitality 
of both teachers and pupils to such an extent as to prevent either one 
from accomplishing what he otherwise might have done. 

The suggestions for the play ground which are to be found in this 
book will go far toward developing a healthy class of children, and the 
suggestions in regard to beautifying the grounds will do much towards 
imbuing the children with a love for the schools. Many of the 
most important suggestions in the book may be carried out 
with little or no expense. This book is strictly in line with the best 
thought of clearly seeing that prevention is vastly better than cure. 
This philosophy is pervading every department of thought, and to the 
extent that it takes a deep hold on our people, future generations will 
have fewer paupers, fewer criminals and fewer invalids. In all these 
cases the underlying philosophy is the same. We must in every case 
ascertain the cause of evil and then we are prepared to combat it in- 
telligently. 



The only way to learn to do is by doing. It is no more rational to 
attempt to educate young people by lectures than it would be to tell 
a potato plant in a dark cellar what sunshine is like, and then expect it 
to develop chlorophyll. Education means training, and this is only to 
be secured by the proper use of well fitted laboratories. 



152 PUBLIC SANITATION AND OTHER PAPERS 



*SHALL THE TONSILS BE REMOVED? 

Almost all of our large cities, and many of the smaller ones, are 
employing medical inspectors to examine the school children. Care- 
ful examinations are made of the condition of the eyes, ears, nose, 
throat, powers of digestion and other things which pertain to the 
ability of the child to master and assimilate his school work. So far 
as the principle is concerned these examinations are exceedingly use- 
ful, and where the work is wisely done many children who have in the 
past been considered stupid and inefficient have their defects pointed 
out and remedied in such a way as to enable them to become efficient 
workers. Where the work is not wisely done serious results may fol- 
low. So much advancement has been made in the application of sur- 
gical methods that there is serious danger of the physicians advising 
surgical work where such work is really not entirely necessary. Owing 
to our imperfect knowledge of physiology it is quite possible that we 
fail to appreciate the full importance of some organs. Among those 
whose real importance may be underestimated are the tonsils. The 
full significance of these organs can only be appreciated after one has 
made a careful study of the organs of respiration. The trachea and 
all of its branches even to the ends of the respiratory bronchioles are 
lined with ciliated epithelial cells, and the cilia all move in such direc- 
tion as to force a thin layer of mucous from the branches into the 
trachea and through the trachea up to the pharynx. This mucous is 
secreted by the epithelial cells lining the above mentioned air pas- 
sages. A careful study of the air and the nature of respiration shows 
the valuable work accomplished by this upflowing current mucous. 
If respiration is carried on through the nose as it should be all of the 
coarser dust particles of the air and many of the bacteria are strained 
out of the air in its passage. Most of the dust and bacteria 
passing through the nose and entering the trachea is caught 
sooner or later in this ascending current of mucous and thus the 
lungs are partially freed from danger of infection. This mucous is dis- 
charged from the trachea into the lower portion of the pharynx in close 
proximity to the tonsils, and from there it from time to time passes 
down through the esophagus to the stomach where the bacteria are at 
least in part destroyed by the action of the gastric juice. From what 
has been said it will be noted that the lower portion of the pharynx 
must always contain large numbers of bacteria. 

The tonsils are composed of what is known as adenoid tissue, which 

*West. Ost., March, 1909. 



SHALL THE TONSILS BE REMOVED? 153 

upon the whole very much resembles lymphatic glands. Tissue of this 
character is distributed through almost the entire length of the alimen- 
tary canal, and one of its functions is to repel and destroy bacteria which 
otherwise might penetrate the epithelial lining of the alimentary canal 
and thus bring about an infection of the underlying connective tissue. 
Nature seems to have developed the tonsils in response to this danger 
of bacterial infection, and when they are incapacitated for action either 
because of their extirpation or from their pathological condition bacter- 
ial infection of this region becomes a comparatively easy matter. The 
tonsils are well supplied with blood because of the activities which are 
demanded of them, and, like other organs having a large blood supply, 
there is always a possibility of their becoming congested because of im- 
perfect drainage. If this condition is allowed to become permanent, 
the condition of the tonsils may become such that their extirpation is 
necessary. But if the great importance of these organs is understood 
they would receive proper care before so disastrous an operation is 
forced upon the patient. 

It is truly remarkable how readily inflamed tonsils yield to in- 
telligent osteopathic treatment. Perhaps another reason why the tonsils 
are especially subject to disease is because they are in a part of the 
body which has undergone profound modification during embryonic and 
foetal development. A careful study of the pathology from the stand- 
point of embryology is sufficient to convince us that those parts of the 
body which have been most profoundly modified during foetal develop- 
ment are the parts which are the most subject to disease. 

It is of course quite conceivable that the tonsils may become so 
seriously diseased that their surgical removal is the only solution of the 
problem. The same thing may be said of the right hand; but just as 
the intelligent person will take such care of his hand as to save it from 
the possibility of amputation, so will the intelligent person care for his 
tonsils and for the tonsils of those who are dependent upon him. Be- 
fore the physician advises the removal of tonsils he should fully under- 
stand the great physiological importance of those organs, and he should 
be sure that they are so diseased that no treatment will enable them to 
recover, and again assume their normal function of preventing the 
bacterial infection of the connective tissues of the throat. It is highly 
probable that many cases of tuberculosis of the throat are due either 
to the surgical loss of the tonsils or their inability to perform the 
physiological functions which nature has imposed upon them. 



154 PUBLIC SANITATION AND OTHER PAPERS 



*THE GONOCOCCUS 

I believe there is a misapprehension in regard to the nature of 
gonorrhoeal infection. It is true that blood is a good germicide. It 
is perhaps the best there is in the human body. The gonococcus lives 
upon the mucous surface, that is, upon the epithelial cells, and there 
is no circulation of blood in the epithelial cells, hence the gonococcus 
is entirely away from the possible influence of the blood or any portion 
of the blood. What the blood can do, as I understand it, is by good 
circulation to keep the deeper tissues in a healthy condition. It 
is possible by increasing the circulation through those parts to make 
the production of epithelial cells more rapid than would be possible 
without a good circulation. The gonococcus lives either inside the pus 
cells or in the epithelial cells. In either case it causes the death of the 
cell. The epithelial cell by its desquamation carries off the gonococcus 
and to that extent frees the part from infection. If there is good circu- 
lation through those parts so that there may be a rapid reproduction of 
epithelial cells it is possible to produce natural cells which, of course, 
are not infected, and in that way very materially aid in reducing the 
infection. We would stultify ourselves in the eyes of those who know 
if we should talk about the blood destroying a gonorrhoeal infection. 

I wish to emphasize the fact that the best possible circulation in 
the heart could not possibly destroy a gonorrhoeal infection. In order 
to be removed it must be done by antiseptics which will destroy the 
bacilli, making it possible to build up new tissue, and make it healthy. 

When we make an examination of infectious disease of the urogeni- 
tal tract and find a diplococcus present it is not by any means certain 
that the diplococcus is a gonococcus. It is sometimes difficult to prove 
that a diplococcus is a gonococcus. If it is one of those cases which 
seems to yield readily to treatment, and where there is little or no ten- 
dency to a relapsed condition, it would seem to me to be pretty good 
evidence that that special diplococcus is not a gonococcus, because the 
gonococcus seems to be especially virulent, and while I am not pre- 
pared to say that the cure is an absolute impossibility, I am prepared 
to say from a knowledge of many cases where I have made the labora- 
tory examination, that the cure of true gonorrhoea seldom or never is 
effected. 

Another thing which we must remember is that there is a very 

♦Discussion, A. O. A., 1910. Pub. in Jour. A. O. A., Feb., 1911. 



HOW LONG SHALL WE LIVE? 155 

great difference between the gonorrhoeal attack in the male and the 
female; that a gonorrhoeal infection of the female is very much more 
dangerous than a gonorrhoeal infection of the male; that the urine 
passing through the urethra being sterile has a tendency all the time 
to wash out the gonococcus from the male, and it is possible that there 
are a good many cases of incipient infection which may be cured in 
that way without much of any treatment. When I said I did not believe 
it was cured I meant if it goes into the deeper glands of the urethra. 
But in its incipiency it is quite possible that the sterile urine in washing 
over it may effect a cure. You know that is the German army treat- 
ment of the disease. The patient is compelled to drink until there is 
a very large secretion of urine which passes through the urethra, and 
certainly in many cases it appears to either cure or relieve. In the 
case of the female, where the infection is in the vagina, and where it 
moves toward the uterus, it is obvious that there is nothing which 
tends to relieve that situation ; that the tract being entirely free from the 
kidney secretion cannot be helped in the same way in which the disease 
in the male can be helped. 



*HOW LONG SHALL WE LIVE? 

Almost every one is familiar with the scriptural statement that 
"the years of a man's life are three score and ten," etc. Very few 
people seem to be familiar with the fact that Moses said the Lord told 
him in a face-to-face conversation that man should live one hundred 
and twenty years. We are strongly of the opinion that the human race 
would be much benefited could they familiarize themselves with this 
latter statement. The "three score years and ten" doctrine is so thor- 
oughly ground into the minds of people that they are unconsciously 
hypnotized into old age at about that period. Were we all imbued 
with the idea that when we have reached the age of three score years 
and ten we yet have fifty years of life before us, we believe that the 
human race as a whole would be much more effective. It seems a little 
strange that the statement of an unknown poet should appeal to us 
with such force when the direct statement attributed to Jehovah makes 
so slight an impression upon us. We have no desire to engage in 
theological discussions, but we ask our readers to seriously consider 
the advisability of teaching people that three score years and ten does 
not necessarily end a man's period of usefulness. 

*So. Pas. Rec, Dec, 1913. 



156 PUBLIC SANITATION AND OTHER PAPERS 



-OLD AGE. 

In 1904 Dr. Elie Metchnikoff delivered a lecture before one of the 
learned societies of Paris on the subject of old age. In this he discussed 
the factors which bring about this condition. In this brief paper I wish 
to present an abstract of his lecture, and shall take the liberty of adding 
to it a few thoughts which have developed since the time that the 
lecture was delivered. 

The problem of old age is a difficult one to solve — in fact, no one 
ever knows exactly when it begins. Some of the characteristics are a 
dry skin, more or less wrinkled, usually pale, hair white, body bent, slow 
walk, defective memory. In the minds of many people, baldness is asso- 
ciated with age. This is by no means a characteristic of that period of 
life, as many people lose their hair while still in the full vigor of life. 
Experience rather indicates that if a person does not begin to lose his 
hair in early life, he is not likely to be bald in age. 

The status of old people in society is by no means uniform. Among 
savages it is not unusual for the aged to either be exposed to conditions 
which will certainly result in death, or for them to be absolutely killed. 
Among some of the African tribes it is not unusual for the aged to be 
buried alive. Among less cultured people, love of life frequently in- 
creases with age. 

As old age comes on, there is frequently a marked disintegration 
both of the skeleton and of the muscular tissues. This disintegration 
necessarily results in a weakening of the individual and in making him 
much more liable to accidents. No one did more than Virchow to inves- 
tigate this tendency towards degeneration, and it seems an irony of fate 
that he should die at the age of eighty-two as the result of an accident 
due to this degeneration. As age advances, some of the cells of the body 
seem to lose their power of reproduction and, strangely enough, the 
reproductive powers of other cells seem actually to be increased. The 
cells which lead to the production of the nails and hair of the head seem 
to retain their reproductive power without much variation. The epithe- 
lium cells of the kidneys, the liver and probably the other glands of the 
body lose their reproductive powers to a great extent, but the cells which 
produce hairs on the face frequently become more active as age ad- 
vances. This is much more marked in some races than in others, and 



West. Ost., Nov., 1913. 



OLD AGE 157 

more marked in the female than in the male. Many Mongolians are 
without beard until late in life, when the beard grows with some luxur- 
iance, and it is not unusual, even in our own race, for the female face to 
have the down of early life replaced by well-marked hairs late in life. 

The destruction of the tissues of the body seems to be brought about 
by the development of cells closely related to the white blood corpuscles. 
These destructive cells are known as macrophages. These macro- 
phages not only attack the tissue cells of the body, but they destroy the 
pigmentation of the hair and skin, leaving one pale and causing the 
other to turn white or gray. Macrophages may be due to toxins as well 
as to advancing years. It is not unusual for those engaged in smelters 
to undergo senile degeneration early in life. The same is true of those 
who are exposed to the dangers of poisoning by phosphorus. It is also 
probable that the development of macrophages may be due to autoin- 
toxication produced by excessive putrefaction in the alimentary tract. 
It is probable that toxins produce anti bodies, which at least partially 
neutralize the injurious effects which the toxins might otherwise exe- 
cute. It is a curious fact that birds age much less readily than quad- 
rupeds. This is true when birds and quadrupeds of the same size are 
compared with each other. Birds whose weight is about the same as 
that of mice live from three to five times longer than do mice, and near- 
ly the same proportion is observed when larger birds and larger quad- 
rupeds are compared with each other. Metchnikoff attributes the 
longevity of the bird to the fact that it has no large intestines, and hence 
there is not the opportunity for intestinal putrefaction which is found in 
mammals. The alimentary tract of mammals, and especially the large 
intestine, is remarkably rich in its bacterial content, while the alimentary 
canal of the bird is singularly free from bacterial inhabitants. Met- 
chnikoff suggests that the evil effects of bacteria in the human being may 
be in part overcome by inoculating the alimentary tract with luxuriant 
growing bacteria, which will destroy the toxin producing bacteria and 
thus prevent the formation and absorption of deleterious products into 
the circulation. He believes that the lactic bacillus is, on the whole, one 
of the most practical for this purpose, and he would have people inocu- 
late themselves with this organism by the use of curdled milk, in which 
it is growing abundantly. He would also have people avoid reinfection 
of the alimentary canal by avoiding all uncooked foods — radishes, let- 
tuce, and most kinds of fruit are well covered with bacteria, and, ac- 
cording to his idea, these should be eliminated from the food list and 
cooked food should be substituted for these. In his lecture, Dr. Met- 



158 PUBLIC SANITATION AND OTHER PAPERS 

chnikoff quoted the following rules of health from an aged physician 
of London by the name of Dr. Weber: 

"All the organs must be preserved in a state of vigor. Morbid 
tendencies, whether hereditary or acquired during life, must be recog- 
nized and combated. Moderation must be used in the consumption of 
food and drink as well as in the pursuit of other corporeal pleasures. 
The air within and about the dwelling must be pure. Corporeal exer- 
cise must be taken daily in all conditions of weather. In many cases 
it is also necessary to take respiratory exercises as well as to walk and 
climb. One must retire early and rise early. Sleep should be limited 
to six or seven hours. Every day a bath should be taken, or the body 
well rubbed. The water employed for this may be cold or warm, ac- 
cording to individual temperament. Some times warm and cold water 
may be alternately employed. Regular work and intellectual occupation 
are indispensable. The mental attitude should be that of enjoyment of 
living, tranquility of mind, and hopeful conception of life. On the other 
hand, the passions and nervous disturbances of sorrow should be corn- 
batted. Finally, one should have a firm determination that will compel 
the preservation of health, the avoidance of alcoholic liquors and other 
stimulants, as well as narcotics and analgesic substances." 

It would seem improper to close even this brief synopsis of Dr. 
MetchnikofFs lecture without reminding the reader that age has its uses 
as well as youth. It really seems that the contempt which many people 
have for the aged is based upon traditions which have come down to us 
from the time when the principal business of man was to engage in war. 
In extreme age it is undoubtedly more difficult to memorize facts than 
it is earlier in life, but with age there may came a calmness of thought 
and a dispassionate view of life which may make the counsel of the aged 
almost invaluable to the world. Among women, especially, it seems to be 
true that with the approach of age there comes a breadth of thought and 
of sympathy which is entirely unknown to the young woman. The best 
intellectual work is usually done by women after they have passed the 
forty-fifth year of their lives, and it is highly probable that as men shall 
abandon excesses of all kinds, their minds will become clearest after the 
passion and fever of early life have passed away. 



The search for happiness is never rewarded by happiness ; but 
happiness comes always and everywhere from self-forgetfulness in 
doing whatever useful work comes to one's hands. 



WHEN THE PATIENT DIES 159 



-WHEN THE PATIENT DIES. 

No one in modern society comes into closer relationship with 
another than does the physician with his patient. He is almost invari- 
ably present when we are born, and it is not considered respectable to 
die without his ministrations ; and between the period of birth and death 
his services are in frequent requisition. 

When a patient dies, his immediate friends and relatives are not 
only incapacitated for intelligent action because of their grief, but 
they immediately become the victims, partly of custom and partly of 
funeral directors, a part of whose business training has been to profit 
themselves as much as possible by the inability of the family to trans- 
act business in a business-like way. It too often happens that the physi- 
cian is under such obligations to the funeral director that he becomes 
almost his silent partner. In other cases, the physician feels that when 
his patient has breathed his last his duties have ended. 

It would be better for all concerned if the physician, moved by the 
impulses which should ever characterize the medical profession, should 
continue for a brief time to be the real friend and adviser of the stricken 
family. Of course, in many cases, such assistance would not be wel- 
comed, and the physician of ordinary discretion would not proffer his 
services in such families. But in many cases the friends and relatives 
are in such a mental state as to be wholly dependent upon some one, 
and it is far better that they should be dependent upon a real friend than 
that they should be dependent upon those who wish to exploit them to 
the greatest possible extent. 

Complaint is heard from every part of our land of the continued 
increase in living expenses. Some attribute this to objectionable tariff 
legislation; others find its cause in the action of the great trusts and 
commercial combinations; some attribute it to the decreasing returns 
of the earth ; a few have hinted that the enormous size of ladies' hats 
may not be without effect. With as much, and possibly more, reason, 
I venture to suggest that one cause is the increasing expense of what is 
called a respectable burial. Seriously speaking, it appears highly prob- 
able that the advance in the cost of living is not due to any one thing, 
but is due to a combination of many causes, and the welfare of humanity 
demands that this cost shall be reduced. 

Human feeling is such that few people have the courage to defy 
the common usages of society by practicing rational economy in the 

*West. Ost., March, 1910. 



160 PUBLIC SANITATION AND OTHER PAPERS 

matter of disposing their dead, and yet it is a manifest wrong to spend 
so much in funeral expenses that the living shall seriously suffer. I 
have known more than one case where the living children were forced 
into serious suffering because of the unnecessary expense incurred in the 
funeral of one dead child. 

The physician can go far toward changing all of this if he has sense 
and tact. The mother, heartbroken over the death of her child, will 
seldom have the courage to count the cost of its funeral ; but if she can 
be sustained by the calm counsel and direction of one in whom she has 
implicit confidence, she may be induced to refrain from expenditures 
which would seriously imperil living ones who are just as dear to her. 
I think that Roman Cato once said : "It is hard to save a city where a 
fish brings a greater price than an ox." Modern society is in serious 
danger when the cemetery is a close competitor in the matter of expen- 
diture with the public school. To speak plainly, it is absurd to spend 
one hundred and fifty to three hundred dollars for the burial of some 
child who perhaps in years had not had that amount spent upon him for 
comfortable clothing and other actual necessities of life. 

If a reform is to be made along this line, it must be largely initiated 
by physicians. Thirty-five hundred dollar burial caskets and expensive 
monuments have no place in a civilization in which slum districts are 
found in every city. So far as monuments are concerned, it may be 
said that in the great majority of cases they have been erected but a very 
few years before people seriously inquire as to who the person was 
whose name and fame they are intended to perpetuate. 



There is a pathetic absurdity in people getting sick and calling in 
the doctor to help them get well. Certainly we should either smile or 
be provoked with the person who would each day overeat to such an 
extent as to make the services of a physician a daily necessity. It is 
almost as absurd when one shall do this at longer intervals of time. 
It is almost as absurd when one violates other laws of his being and so 
necessitates the services of a physician. In the first case we certainly 
should feel that either the physician or the patient was most grievously 
to blame — the physician to blame for not giving such instruction to the 
patient as to prevent his future violation of his dietetic requirements, 
and the patient to blame for not learning the lesson which his physician 
tried to teach him. In other words, the time will come when we shall 
see the absurdity of the whole system of modern medical practice. 



OSTEOPATHY AND PUBLIC HEALTH 161 



*THE RELATIONSHIP OF THE OSTEOPATHIC PHYSICIAN 
TO PUBLIC HEALTH. 

It happened once upon a time that there was a mountain, and a 
road ran along its side. This road was traveled by every member of 
the human race. For the greater part of the distance the road was 
fairly good, but occasionally there were places where the road was very 
slanting and rough and uneven, and when the travelers came to these 
places, it often happened that they fell from the road down the cliff. 
As the result of this fall, some were killed, others had their limbs 
broken, and all were more or less injured. Partly out of sympathy 
for the unfortunate ones and partly because it was financially profitable, 
a considerable number of kind-hearted men and women banded them- 
selves together and at each of the places where the travelers fell, they 
built hospitals, and supplied them with physicians and nurses, and as 
soon as a person was injured he was tenderly picked up and cared for, 
and if he could be restored to health he was sent back to travel again, 
but it frequently chanced that before he had traveled very far he met 
with another accident, and was in like manner again cared for. At a 
later time in history, some one conceived the idea of building fences 
and walls along these dangerous places ; and after these were built, 
the travelers were unable to fall, and often they were able to pass the 
entire length of the road uninjured and in safety. These kind-hearted 
men and women who built hospitals and cared for the injured were 
people even the same as you and I. The people who built the walls 
and fences and made it impossible for the people to fall over the preci- 
pices, were the public hygienists. 

Every one of us is first and above all a citizen of our country and 
of the community in which we live. As public spirited citizens, every- 
thing which makes for the welfare of the community is of interest to 
us. It is true that professionally we are physicians. It is true that in 
a measure, we profit by the sickness which is in our communities ; but 
if we do not strive to prevent that sickness, we fall far short of good 
citizenship. 

PREVENTABLE CAUSES OE ILL HEALTH. 

A large part of the sickness from which the human race suffers is 
to be attributed to one or more of four preventable causes : Bad air, 
bad water, bad food, and bad personal hygiene. If these four condi- 
tions were corrected, it would be no exaggeration to say that we could 

*Jour. A. O. A., Oct., 1908. 



162 PUBLIC SANITATION AND OTHER PAPERS 

wipe out of existence ninety per cent of the sickness from which people 
suffer, and death until old age, except as the result of accident, would be 
almost unknown. 

BAD AIR. 

By good air is meant air .which nearly approaches the air as it is 
out of doors in the country. Ordinarily good air, such as we find in 
country places, and in the less congested parts of our cities, contains 
about four parts of carbon-dioxid to ten thousand parts of the other 
constituents. The amount of carbon dioxid may be double in air with- 
out it becoming very injurious. But if the amount of carbon dioxid is 
increased much above eight parts in ten thousand — then those who are 
confined within it suffer from headache, from drowsiness, and from a 
general physical depression. It is our duty as physicians, our duty 
as citizens, to try to see that dwelling houses, churches, and all places 
v/here people assemble, in the communities in which we live, are pro- 
vided with proper ventilation. In any hall where people are assembled 
for any length of time, there should be about sixty cubic meters of air 
space for each individual, and each hour there should be an opportunity 
for about 100 cubic meters of air to pass into the room, and about the 
same amount to pass out of it, for each individual. If these conditions 
prevail, then we are safe in saying that we have good ventilation. If 
anything less than this prevails, the ventilation is not what it should be. 
There is a general impression upon the part of many people that bad 
odors are necessarily unhealthful. I am not here to argue in their 
favor. I dislike them as much as most persons, but the fact remains 
that there may be a very bad odor in the neighborhood, without the air 
being necessarily unhealthful, and especially are we to remember as 
physicians, that the worst odor in the world does not result in typhoid 
fever or any other specific disease. Typhoid fever and other infectious 
diseases come from totally different sources. The bad odors may lower 
one's vitality, and in that way may predispose persons to disease, but as 
before stated the bad odors themselves do not produce disease. 

Dust is always to be regarded as dangerous for at least two rea- 
sons. One is that it is irritating to the throat and lungs and tends to 
bring about a congested condition of these organs and this makes 
it easy for persons to contract disease, but the worst feature of dust is 
that it is often laden with bacteria and frequently with pathogenic bac- 
teria so that if the throat is irritated and its powers of resistance are 
made less by the dust, the bacteria may gain a foothold and some form 
of throat disease may follow. Wherever we may be it is a good plan 



OSTEOPATHY AND PUBLIC HEALTH 163 

as citizens to favor sprinkling the street and doing all that we can 
toward keeping the dust down. 

BAD WATER. 

A cup of cold water seems about as good a thing as it is possible 
for one person to offer another, and yet a cup of cold water, pure and 
sparkling as it may appear to be, may be the source of disease and 
grave danger. On the other hand water which looks very impure may 
be a reasonably safe water to drink. Public drinking cups in the cars 
and other public places are a serious menace to public health. All 
water that is contaminated by sewerage in any way is dangerous and 
extremely dangerous. All wells that are in the immediate vicinity of 
vaults may be more or less contaminated because germs of disease will 
ultimately pass through the ground into the water. I remember a little 
town in Illinois which was for years and years cursed with typhoid 
fever. People died by the score. It was an almost continuous scourge. 
The ministers used to hold funeral services and tell us how "the Lord 
had called this one and that one home." In later years the town put in 
a system of water works, and piped pure water into the houses, and 
from the time of the completion of the water works until the present 
day the number of deaths from typhoid fever has been reduced almost 
to zero. 

The question arises as to how the physician engaged in general 
practice can tell whether a given sample of water is free enough from 
bacteria to be safe. This is not an easy thing to do, but there is a test 
which is a reasonably safe guide. It is performed by making a simple 
culture medium of gelatine, such as we use in the bacteriological labor- 
atory, in an ordinary petri dish. After the gelatine is sterilized take a 
small amount of the water which you desire to test, mix it with a very 
much larger quantity of water which has been sterilized by boiling so 
as to dilute the water which you are testing and pour a small quantity 
over the gelatine. If in the course of a day or two the gelatine is 
liquefied by the bacteria which are growing in it, it is an indication of 
dangerous water. If on the other hand the number of bacteria which 
produce liquefaction is not large the water is in all probability reason- 
ably safe. Most pathogenic bacteria with which we have to deal liquefy 
gelatine rapidly. The non-pathogenic bacteria as a rule do not readily 
liquefy gelatine. 

Water companies, and those who are interested in showing that 
water is all that it should be often view it only from a chemical stand- 
point. Hygienists agree that an examination which shows the 



164 PUBLIC SANITATION AND OTHER PAPERS 

water pure from a chemical standpoint does not prove that the water 
is fit for drinking. Water may be bad from a chemical standpoint with- 
out being in danger of carrying disease and it may be perfect from a 
chemical standpoint and still contain bacteria which render it dangerous. 

BAD FOODS, MILK. 

Another source of danger is in milk. I believe that infant mor- 
tality from the use of impure milk is enormously greater than most of 
us realize. Milk above all foods should be pure. From a chemical 
standpoint it should be up to a high though just standard. Ordinary 
cow's milk should contain about three per cent fat, three and a half per 
cent proteid matter, and four and a half to five per cent of sugar. Milk 
of this character is good from the standpoint of the chemist, but from 
the standpoint of the public hygienist milk must not only have these 
chemical characteristics, but it must be clean, and in order that it may 
be clean the milkers must be clean. No milk should ever be given to 
an infant where the milker had not carefully washed his hands before 
touching the cow, and in addition to that the cow should be washed be- 
fore being milked. No milk is fit for an infant when there is a tuber- 
cular cow in the herd from which the milk comes. If there is a single 
animal in the herd suffering from tuberculosis she comes in contact 
with the other cows and by coughing may cause saliva and sputum rich 
in bacteria to be thrown upon the sides of the fellow-cows and thus into 
the milk. There is a question as to whether bovine tuberculosis and 
human tuberculosis are the same disease, but that is a question that can- 
not be settled at the present time ; but where there is a possibility of the 
two being the same it is better to guard the infants and assume that the 
two diseases may be the same. Hence milk which by any possible means 
may be contaminated by bovine tuberculosis should be regarded as dan- 
gerous milk to use. 

There are a number of diseases which are spoken of as milk borne 
diseases. As physicians and as public officers (which we are, because 
we are licensed by the state in which we are practicing) it is our busi- 
ness to intelligently trace the origin of disease. If the physician has a 
case of diphtheria, it is not enough for him simply to treat the case, 
and put the patient on the road to recovery, but it is his duty to at- 
tempt to find out where the disease came from. People do not "just 
get diphtheria" any more than they "just get eaten up by a lion." We 
are not eaten by a lion unless there is a lion around. We do not have 
diphtheria unless the bacilli of diphtheria are in our throats. The throat 
may be congested and may form a fine nidus for bacteria, but we do not 



OSTEOPATHY AND PUBLIC HEALTH 165 

have diphtheria unless the bacilli are present and it is the duty of the 
physician to try and find where it comes from in order that he may 
assist in saving others from the disease. So far as we know diphtheria 
is not transmitted by water, but it is very commonly transmitted by 
milk. If milk is obtained from a family in which some person is suffer- 
ing from diphtheria it is possible for the milk to become contaminated 
unless the greatest care is used, and in that way the milk may become 
a source of danger. The same thing is true in regard to tuberculosis 
and scarlet fever. It is probably no exaggeration to say that in nine 
cases out of ten when there is an epidemic of diarrhoea or summer com- 
plaint amongst children it comes from milk, and when it does not come 
from milk it comes from some other article of food. 

Thrush is another disease which is very commonly carried by milk. 
Whenever milk which must be used is suspected of being infected by 
any pathogenic organisms, pasteurization is the proper treatment. This 
is accomplished by raising the temperature of the milk to 165 or 170 de- 
grees Fahrenheit, and then cooling it as quickly as possible. By so 
doing most of the bacteria in the milk are destroyed and the keeping 
qualities of the milk are very greatly increased. 

FLIES. 

Another end for which physicians as public spirited citizens should 
work is the extermination of the abominable dirty house fly. There was 
a time in the history of our race when flies were useful, when in the 
great cities dead cats and dogs and rats were thrown promiscuously into 
the streets and it was a good thing to have flies to devour the filth, but 
cleanly as we are endeavoring to become, the fly is a nuisance. The 
tuberculous patient expectorates in the street or elsewhere, and the flies 
almost immediately alight upon the sputum and then enter our houses 
and places where articles of food are kept. Flies visit sick animals and 
settle on the sores and become contaminated with the pus and carry it 
into our houses. I have known three cases of antinomycosis where the 
disease was almost certainly transmitted to the patient by the house fly. 
The flies get into the pus of the animal suffering from the disease, and 
then by coming in contact with some abrasion of the human skin the 
spores of the mold are transmitted. Flies do not just simply "come." 
They come from places — filthy places. Do away with the filth and with 
decomposing matter, and you do away with the breeding places of the 
flies. There are only a few flies that ever managed to live through the 
winter in a severe climate. Those which do live through the winter de- 
posit their eggs in places where there is decaying organic matter and in 



166 PUBLIC SANITATION AND OTHER PAPERS 

a short time there are myriads of flies. Physicians should work for that 
cleanliness which will rid the country of flies, and in doing it we not 
only add to the comfort of the people at large, but we do much in the 
way of promoting public health. 

BAD PERSONAL HYGIENE). 

In regard to personal hygiene there is much which might be said. 
Plenty of sleep is necessary to health. There are a few people who can 
rob themselves of a certain amount of sleep and still do their daily work ; 
but there are none, who can rob themselves of necessary sleep without 
shortening their lives ; and without lowering their efficiency as men and 
women. It is a good thing to live to be eighty years of age, but there 
is a more important thing than living eighty years and that is to live 
such years as we have efficiently. It is better to die at fifty and have 
had years of vigor than to die at ninety and to have lived the last fifty 
years in such poor health as to destroy one's efficiency. Long life is 
good only so far as we are useful. If sleep is important to mature men 
and women it is vastly more important to children. All reasonable in- 
fluence should be exerted against evening parties for children. Enter- 
tainments of all kinds which keep children up to a late hour are not 
only injurious to health but are absolutely destructive. The child 
comes home exhausted from such places unable to sleep because his 
nervous system is in a quiver. As physicians properly interested in 
public health and prosperity we should do everything in our power to 
bring the next generation up to the highest state of usefulness. 

Most of us respect an ancient faith whose rules of conduct are ex- 
pressed in ten different commandments. The Buddhists have con- 
densed their moral code into five commandments. One of them which 
should appeal to us strongly is : "Shun drugs and drinks which work 
the wit abuse; clean hearts, strong bodies, need no Soma juice." If 
we should bring up our children with the thought that all drugs and 
drinks which work the wit abuse are to be discarded, we would go very 
far towards helping them to grow into a stronger and better manhood 
and womanhood than they otherwise can. I think that even those who 
are addicted to the use of the weed will excuse me for saying that it 
is not good for children. I will not discuss the effect of tobacco upon 
the adult at this time, but children are seriously injured by it. The 
little boy on the streets, who at the age of six or eight or ten years 
learns to smoke cigarettes is doing that which makes a strong and 
vigorous manhood impossible, and it is our duty as physicians to make 
this known and to work for better conditions. 



OSTEOPATHY AND PUBLIC HEALTH 167 

DISINSECTION. 

All will agree as to the extreme importance of recognizing all 
cases of communicable disease and reporting them promptly to the 
proper officer. The physician who fails to recognize and report small 
pox, diphtheria, scarlet fever, measles, bubonic plague and many other 
contagious diseases not only makes a most serious mistake but he com- 
mits a crime against the whole community. It is customary with some 
physicians to report deaths from tuberculosis as pneumonia cases. This 
is often done to please the friends of the deceased and because it is 
thought that no harm can come from the deception. The evil of this 
is that the room and house in which the person has died is not properly 
disinfected and thus innocent persons may be exposed to the danger of 
contagion. Cases are not rare where several persons have contracted 
tuberculosis from living in a house in which there had been a tuber- 
cular patient and which had not been properly disinfected. 

It is the duty of the attending physician in all cases of acute sick- 
ness to be sure of the thorough disinfection of the house in which the 
patient has either recovered or died. If there is an efficient health de- 
partment in the city it is the business of the health officer to attend to 
disinfection, but in many of our smaller places the health department 
is very lax and then it is the duty of the attending physician to protect 
the other members of the family from contracting the disease from 
which the sick member suffered. 



We should not be content with the development of osteopathy 
until we find ourselves standing shoulder to shoulder with other phy- 
sicians in investigating these great problems, which are of such im- 
port not only to large areas of our country, but almost to civilization 
itself. That there is much work for us to do is evident when we know 
that we have not one representative in conferences of this kind. 



Osteopathy may be hampered by mediaeval legislation, but the 
only thing that can ever kill it is for its practitioners to cease to be 
progressive. No system can rest for any length of time upon political 
aid. The only thing upon which we can ultimately depend for our 
security and our success is to be so faithful to the interests of humanity 
that the people shall feel that we are absolutely essential to their well- 
being. When, by our faithfulness, our education and our skill, we can 
bring about this feeling, our position is absolutely invulnerable. 



168 PUBLIC SANITATION AND OTHER PAPERS 



*WHAT OF THE FUTURE? 

Prophesying without time limitation is one of the most innocent 
amusements in which one can indulge. It is, of course, quite possible 
that the prediction will never come true; nevertheless the prophet is 
quite safe, because he has the indefinite future to which he may point 
the doubting mind. 

Sir Aim Roth E. Wright has prophesied that "the physician of the 
future will be an immunizer." I would like to suggest the possibility 
that the physician of the future will be a preventer of disease rather 
than an immunizer. At first thought there appears to be little difference 
between the two, but when one analyzes the situation more closely, he 
sees that they are separated from each other by a great gulf. The im- 
munizer assumes that conditions favorable for contracting disease are 
ever present, and so he proceeds to place his patient in such condition 
that he shall not become infected, or if he does become infected, that 
the infection shall be mild in character. The immunizer assumes that 
automobile speeding is inevitable, and so he proceeds to devise suits of 
armor which will make it reasonably safe for one to be run over by 
one of these vehicles. The physician who believes in preventive medi- 
cine believes that speeding itself can be stopped, and hence that the 
armor, no matter how efficient, will be needless. 

I am inclined to believe that the best thought among physicians 
of all schools is along the line of preventing conditions which make 
disease possible rather than in immunizing patients from disease. 

A recent discovery by Mr. A. J. Baldwin, of New York City, 
promises to go far in the line of preventing disease. For the last ten 
years we have known that diphtheria, scarlet fever, typhoid fever, 
tuberculosis, and perhaps some other diseases, are widely spread by 
milk, and public hygienists and technical bacteriologists have worked 
faithfully trying to improve the character of the milk offered for sale. 
The work done has led to a marvelous improvement in regard to the 
character of milk. Not many years ago, it was not difficult to find 
milk offered for sale which contained more than one hundred million 
bacteria to the cubic centimeter. Under improved dairy conditions, 
the number has in many cases been reduced to somewhat less than fifty 
thousand ; but when one reflects that a cubic centimeter consists of only 
a few drops of milk, it will readily be seen that even at the last named 

*West. Ost., May, 1910. 



OSTEOPATHY AND PUBLIC HEALTH 169 

figure the number of organisms in the amount of milk which a baby 
would take at a single meal is so enormous as to defy the power of 
human conception. Mr. Baldwin claims that practically all bacterial 
and protozoan life can be destroyed in milk by charging the milk with 
carbon dioxide gas, and that when the milk is thus charged it may be 
transported almost any distance without deterioration. It is claimed 
that the carbon dioxide gas can be readily removed from the milk by 
simply pouring it in a thin layer from one dish to another, but that for 
ordinary purposes its presence in the milk is beneficial rather than 
hurtful. The discovery is too new to make it safe to make predictions 
as to its value, but if it accomplishes what Mr. Baldwin believes it 
will accomplish, it is one of the great discoveries of the century and 
it will go far toward relieving the immunizing physician of work which 
he otherwise might be called upon to do. 

Other causes for the spread of disease are the several kinds of 
flies. It is quite likely that at one time in the history of the race the 
fly was beneficial rather than harmful. That was when people were 
much less cleanly than they are at the present time and when dead 
animals and animal filth were common in the streets of our cities. 
Under those conditions, the flies, by causing them to be quickly de- 
voured, perhaps did more good than harm ; but now, with our greater 
cleanliness, the flies have become an unmitigated nuisance. They do 
very little good, if any, and are certainly an important factor in the dis- 
semination of disease. Not only does the fly spread disease from one 
human being to another, but it acts as a carrier of disease among both 
lower animals and plants. Some of the most destructive diseases to 
which trees and fruit are subject are believed to be spread by the fly. 
So far as we know, the fly breeds only where there is decaying organic 
matter. If this be the case, the obliteration of flies is simply a question 
of cleanliness. 

There is good reason to believe that the hook worm plays a most 
important part in the reduction of the physical and mental energies 
of large numbers of the people in the South, and it has been reported 
as gaining a foothold in California. This parasite is spread solely by 
a lack of attention to ordinary cleanliness. Wherever sewage is spread 
over the ground, there is a possibility of the barefooted child contract- 
ing this disease. Even if we knew some means of immunizing against 
this pest, it would probably be very much better to improve our sewage 
systems and sanitary conditions than to practice immunization. The 
methods of preventing malaria are known perfectly well, and it is 



170 PUBLIC SANITATION AND OTHER PAPERS 

simply a question of expense and judgment as to whether we shall make 
use of these means or suffer from the ravages of the disease. 

When the institution of chivalry was at its height in the very 
flower of its glory in the latter part of the sixteenth century, Cervantes 
wrote Don Quixote. The book was interesting and amusing, and 
chivalry was a thing of the past, because everybody laughed at it. 
We shall some time awaken to the absurdity of our present system 
of living, to the absurdity of permitting such conditions of public 
and private hygiene as to make disease possible and then employ a 
great army of immunizers or other kind of physicians to help us re- 
cover from disease which we can prevent by intelligent action; and 
then our present methods will be changed as rapidly as were the social 
conditions in the days of Don Quixote. Impure water systems, dirty 
dairies, questionable meat, and adulterated foods of all kinds have got 
to go, and with them will go the immunizer and the physician whose 
only thought is to relieve people who are sick from preventable diseases. 

Let us, as physicians, lend every aid to bringing about better sani- 
tary conditions. It may force us into a change of occupation, but there 
is more dignity and more value in the skilled hygienist than there is in 
the immunizer. 



One thing which we feel like criticising a little is the half-apolo- 
getic air of many of the Osteopaths. We hear more than one of our 
professional brethren justifying his profession by the staunch declara- 
tion that it was "just as good as any other system." Now, as a matter 
of fact, if it is not a great deal better than any other system, Osteopathy 
has no place in the world. 

We would not intentionally stimulate our people into a vain and 
foolish arrogance, but we would have them understand that their pro- 
fession lives and will continue to live only because it is a system supe- 
rior to anything which the world has previously had. While common 
sense and ordinary professional modesty must unite to prevent our 
making foolish claims for ourselves and our profession, still let us 
have the feeling born of proper self-respect and of a knowledge of real 
conditions that we have so far as we know the best system of treating 
disease which the wisdom of the ages has thus far evolved. 



PART II. 
Scientific Investigations 

*THE DEVELOPMENT OF THE EPITHELIAL ORGANS. 

The following paper is based upon the study of a series of embry- 
onic mice. The greater part of it is simply a confirmation of facts long 
since enunciated, but some deductions have been drawn which I be- 
lieve have not previously been published. It is hoped that this study 
may lay the foundation for work on abnormal growths. 

Epithelium, as the term is used in the present paper, may be de- 
fined as a cellular tissue, one surface of which rests upon a membrane 
known as the basement membrane, the other surface being free. It is 
the first tissue which is clearly differentiated in the embryo. With 
few exceptions true epithelium membranes are either upon the outer 
surface of the body or they line cavities which freely communicate 
with the outside. The most striking exceptions to the last statement 
are the epithelial tissue of the inner ear, the supra-renal capsules, the 
pituitary body, and the thyroid gland. The cells forming the free 
surface of an epithelial membrane frequently have slender hair-like 
projections which are known as cilia. It appears probable that when 
they exist they always develop in the foetus. In their most typical 
form the cilia are freely movable and quite separate, but in many cases 
these projections become highly modified and they may become so mat- 
ted together as to form what is sometimes called the cuticular mem- 
brane. This membrane usually appears structureless and may com- 
pletely cover the epithelial surface. The basement membrane upon 
which the epithelial cells rest is of doubtful origin. In many cases it 
appears to very closely resemble the cuticular membrane, and may be of 
a similar origin. In other cases careful observers have believed that it 
is derived from connective tissue. The epithelial membrane may con- 
sist of a single layer of epithelial cells in which case it is known as 
"simple epithelium*' or it may consist of a varying number of superim- 
posed layers, when it is known as "stratified epithelium." The layer 
of epithelial cells in stratified epithelium, as well as the cells composing 
a simple epithelial membrane exhibit what may be called polarity. 
By this is meant that the structure of the ends of cells nearest the 

*Jour. A. O. A., Dec, 1907. 



172 SCIENTIFIC INVESTIGATIONS 

basement membrane is rather simpler than that of the parts of the cells 
most remote from the basement membrane. This condition might be an- 
ticipated as the free end of the cell is most immediately in contact with 
the external environment and a high degree of organization is necessary 
to enable it to adapt itself to varying conditions. The end of the cell 
nearest the basement membrane is frequently spoken of as the vegeta- 
tive pole of the cell, to distinguish it from the animal pole of the cell 
which is the farthest from the basement membrane. 

REPRODUCTION. 

All typical epithelial membranes are free from both blood and 
lymph vessels, but sensory nerve endings are abundant in almost all 
epithelium. There is a marked difference between the reproductive 
methods of embryonic and adult epithelial cells. When an embryonic 
cell divides it gives rise to two cells neither of which differ in any 
marked degree from the parent cell. In adult epithelial cells, however, 
the foregoing statement is the exception rather than the rule, for in 
these one of the daughter cells resemble the mother cell, while the 
other differs from the mother cell to a greater or less extent. In 
stratified epithelium the cells which differ from the mother cells are 
those which form the superficial layers. Sometimes instead of these 
aberrant cells becoming cemented together, they remain as free, wand- 
ering cells. These are very abundant in the skins, of some scaleless 
fishes. In the mammals they are the cells which are sometimes known 
as macrophages. It is quite possible that these add measureably to the 
protection of the epithelial membrane from bacterial invasion. 

It is proper to note at this place that with the exception of the cells 
of the nervous system, the muscle cells and the leucocytes, the epithelial 
cells are the only active cells found in the animal body. The three first 
named cells are highly specialized in their functions, while the functions 
of the epithelial cells are widely generalized. 

It seems that there is rather a close relationship between the special- 
ization of epithelial cells and the extent to which the epithelial cells 
have pushed into or invaded the connective tissue. This statement ap- 
pears to embody a general, rather than specific truth. The surfaces of 
plants are composed of cells closely resembling epithelial cells, and the 
glands of such plants as secrete volatile oils are made up of these in- 
vading cells. 



DEVELOPMENT OF THE EPITHELIAL ORGANS 173 

GLANDS. 

This statement is founded on observations made on the umbelli- 
ferae and the liliaceae. All of the true glands of the body are formed 
from invaginations of epithelial cells. Probably without any excep- 
tions this growth primarily consists of a solid cord of epithelial cells 
of the embryonic type. At a later time this solid growth becomes 
tubular from a re-arrangement of the component cells and the deeper 
epithelial cells, by a process of differentiation, become specially fitted 
for producing the secretion or excretion proper to the gland. It may 
be noted that the glands form one of the four kinds of epithelial inva- 
sions, The other kinds are known respectively as dilatations, diverti- 
culae and vesicles. By dilatations are meant enlargements of what were 
once tubes of nearly uniform diameter. The best examples of dilata- 
tions are the stomach, uterus, and bladder. It is possible that the lungs 
should be included in this list. By diverticulae are meant blind out- 
growths from cavities already existing. These are exemplified in the 
bodies, of the higher mammals by the coecum, vermiform appendix and 
possibly by the gall bladder. Both dilatations and diverticulae differ 
from glands by being formed by the harmonious growth of both epi- 
thelial tissue and connective tissue, while glands are purely an epithe- 
lial invasion of the connective tissue. Vesicles are formed by an epi- 
thelial invasion of connective tissue closely resembling gland formation, 
but the epithelium eventually becomes completely cut off from the sur- 
face by the constricting growth of the connective tissue. The best 
example which we have of a true vesicle is the epithelium of the inner 
ear. In early embryonic life this begins as a solid ingrowth of epithelial 
cells which afterwards becomes a hollow sphere and is eventually com- 
pletely cut off from the surface by the growth of the surrounding con- 
nective tissue. As the central nervous system is developed in very 
much the same way. it is perhaps philosophical to regard this also as 
an example of vesicular formation. It would be difficult to over-esti- 
mate the importance of embryonic development of these four forms of 
invagination. The difference between the structure of very simple 
animal forms and the more complex forms is largely due to the differ- 
ences in the invaginations. Two forms of typical glands have been 
recognized by histologists. These are the tubular and racemose. In 
the first the secreting cells of the glands are arranged around a lumen of 
uniform or nearly uniform diameter. In the second the terminal por- 
tion of the lumen is expanded into a sphere which is surrounded by 
the active epithelial cells. The earlier histologists regarded the second 



174 SCIENTIFIC INVESTIGATIONS 

as the more common form of gland, but further research leaves room for 
grave doubt of there being one really good example of a racemose 
gland found in the bodies of the higher mammals. From the stand- 
point of secretion, glands may be divided into two kinds ; the serous 
and mucous. In the mouse (the embryo of which has been extensively 
used in the preparation of this paper) there appears to be no essential 
difference in the development in these two kinds of glands. The secre- 
tion of the serous glands is more watery than the secretion of the 
mucous glands. The serous glands usually elaborate some ferment. 
The secretion of the mucous glands is mucoid in character, and is de- 
void of any ferment. Modern histological methods render it compara- 
tively easy to distinguish between these two classes of glands. The 
cells of serous glands in the resting state are well filled with granules 
from which the ferment is to be formed, while the cells of mucous 
glands present a more nearly homogenous appearance. The salivary 
glands are divided between these groups. The parotid in the human 
being is almost exclusively a serous gland. The submaxillary is a mixed 
gland containing both serous and mucous cells, while the sub-lingual 
is almost invariably mucous in character. All of these glands are fine 
types of the highly developed and specialized tubular glands. 

The poison glands of poisonous reptiles are compound tubular 
glands, closely resembling the salivary glands in structure. The pecu- 
liarity of their secretion is to be explained by their physiological activity 
rather than by their apparent structure. 

Lingual glands which are rather abundant on the posterior portion 
of the tongue are simple in structure and belong to the mucous type. 
The glands of the stomach are upon the whole even simpler than most 
of the glands of the tongue. Like the other glands of the body, the 
gastric glands begin as solid cords of epithelial cells pushing into the 
connective tissue. These cords eventually branch and when the cells 
composing the cord arrange themselves in such a way as to form a 
lumen, it is the cells of the branches which differentiate into the truly 
active cells of the glands. Somewhat before birth a differentiation of 
the gland cells occurs which results in the formation of the special 
cells which produce pepsin and those which secrete hydrochloric acid. 
The enteric glands in the mouse appear to develop simultaneously with 
the villi. The structure of the enteric glands is upon the whole simpler 
than the structure of the gastric glands, as the enteric glands seldom 
branch. As a result of careful study of several adult forms I believe 
that the only cells of the enteric glands which are truly active are those 



DEVELOPMENT OF THE EPITHELIAL ORGANS 175 

situated deep in the crypts, and these are believed to be the only epithe- 
lial cells of the intestine which reproduce themselves. 

The sudoriferous glands begin their development like other glands. 
The most striking peculiarity of their development is that the downward 
growth of the cord of epithelial cells appears to be checked in the con- 
nective tissue, and as the growth continues after the checking occurs, it 
results in the formation of a coil. The cells of this coil are probably the 
most active cells of these glands. The sebaceous glands begin their de- 
velopment like the sudoriferous glands, but their downward growth is 
not checked as is the growth of the sudoriferous glands and they (seba- 
ceous) show more or less of a tendency to branch. The tarsal glands 
(meibomian) are closely related to the sebaceous glands in structure 
and in function, the most striking difference being that the tarsal glands 
show a marked disposition to produce short, thick branches which pass 
off at right angles from the parent stem. 

Ceruminous glands are branched tubular glands often coiled in 
such a way as to closely resemble the sudoriferous glands. The fact 
that their secretion is sebaceous in character while their structure is 
more or less sudoriferous lends possibility to the idea that the sebaceous 
and sudoriferous glands have differentiated from a more generalized 
gland and are thus generically related. 

The tear glands are compound tubular glands. Neither the 
structure nor the development of these glands appear to present any 
striking feature: In an embryonic mouse, three millimeters in length, — 
the different lobes of the glands appeared to be separated from each 
other, so it is quite possible that that which constitutes a single gland 
in the adult may have been developed by the union of several similar 
subordinate glands. 

THE liv^r. 

The first indication of the liver is a diverticulum which eventually 
develops into the gall-bladder. The epithelial lining of this begins at 
an early time to invade the surrounding connective tissue. Most of 
these invasions develop into simple or slightly complex mucous glands, 
but the epithelium on the anterior side of the gall cyst continues its 
development until such a mass of epithelial cells is formed that the 
original diverticulum becomes a mere appendage. It is not quite clear 
as to just how the cells come to arrange themselves so as to utilize their 
blood supply and at the same time discharge their function as bile pro- 
ducers. In the normal liver, all of the epithelial cells appear to have 



176 SCIENTIFIC INVESTIGATIONS 

functional activity and it is probable that no epithelial cells in the body 
have more diversified functions than these. They not only form two 
distinct internal secretions, glycogen and urea, but also the very com- 
plex secretion and excretion known as bile. They also affect certain 
toxines in portal blood in a way not yet well understood. 

THE PANCREAS AND SUPRARENALE. 

The pancreatic gland begins its development almost simultaneously 
with the liver. In its earlier stages as in its adult condition, it closely 
resembles the parotid gland. When the cells begin to arrange them- 
selves so as to form the lumen of the gland, this formation proceeds 
from the end attached to the intestine toward the more distant portions. 

There are certain parts of the gland where the cells never arrange 
themselves so as to form a lumen. These masses of cells are often 
spoken of as "islands" and they have a function which is entirely dis- 
tinct from the function of the other parts of the glands. Physiologists 
have for years recognized these islands as forming an internal secre- 
tion which facilitates the oxidation of sugar in the blood. These islands 
may be regarded from the standpoint of the histologist and embryolo- 
gist as examples of arrested glandular development. 

The suprarenal capsules, the prostate gland, the pituitary body, 
and the thyroid gland constitute a remarkable series of glands. The 
suprarenals represent glands whose development has been arrested at a 
very early stage. In them the epithelial cells have arranged themselves 
in the form of solid cords but no lumen is developed; consequently 
there can be no external secretion. Whatever is formed by these cells 
necessarily passes either into the lymph stream or blood current. The 
pituitary body represents a stage of development one step in advance 
of the suprarenals. In this body acini are formed by the rearrangement 
of the epithelial cells, but the epithelium which connects these with the 
surface degenerates and in no case do these acini communicate with 
the surface, hence of necessity we again have a gland whose secretion 
is entirely internal. The prostate gland represents a stage further 
in advance as the acini communicate with the surface, but communicate 
through many openings instead of discharging through a common duct, 
as is the case with the parotid and pancreatic glands both of which are 
upon the whole much more highly organized. 

In passing it may not be without importance to call attention to the 
fact that almost the entire length of the male urethra is glandular. The 
invaginations or ducts are numerous and while the secretions are prob- 



DEVELOPMENT OF THE EPITHELIAL ORGANS 177 

ably of slight value, the ducts and glands are of vital importance to the 
pathologist, as they frequently become the seat of infection, especially 
gonorrheal, and from these places it is extremely difficult to dislodge the 
gonococcus. 

The thyroid gland is a good example of a gland which has passed 
its highest stage of development and which has in part degenerated. 
This is shown by the fact that in early embryonic life the thyroid gland 
has a distinct outlet through the foramen caecum, at the base of the 
tongue. This outlet is lost as development proceeds and the gland in 
an adult represents about the same type of development as does the 
pituitary body. 

MAMMARY GLAND. 

The mammary gland is represented in the embryo by what is 
known as the milk ridge. This is an epithelial thickening extending 
the entire length of the trunk ; deep invaginations of cords of epithelial 
cells are developed at intervals. In some mammals like the pig, cat and 
dog most of these go on to complete development and may become 
functional. In some other mammals the anterior embryonic glands are 
suppressed and only the posterior ones become functional. The cow, 
sheep and horse, are examples of this. In others the posterior part of 
the milk ridge never develops and the anterior part alone becomes func- 
tional. The primates and elephant are examples of this. In early 
embryonic life, it is impossible to distinguish between the sexes as far 
as the development of the mammary gland is concerned. In both cases 
the embryonic development is marked, but in the male this is even- 
tually suppressed while in the female there is retained at least the possi- 
bility of complete development, though it apparently seldom happens 
that the solid cords of epithelial cells give way to true tubes until about 
the time that the female bears young. A careful study of the mammary 
gland shows that so far as structure is concerned, it possesses some of 
the characteristics of both the sudoriferous glands and the sebaceous 
glands. 

NEUROKPITHKLIUM. 

Almost all fish have a series of sense organs extending the entire 
length of their bodies on either side. These organs constitute the 
"lateral lines," and they are formed by an invagination of the epithe- 
lium. In higher vertebrates both the sensory portions of the nose and 
of the internal ear originate in the same way as do the organs of the 
lateral line, and it is highly probable that they represent the most highly 



178 SCIENTIFIC INVESTIGATIONS 

developed organs of this series. All of the lateral line organs are abun- 
dantly supplied with nerves, and it is in these organs that we find the 
most primitive form of neuroepithelium. By neuroepithelium is meant 
epithelial cells which have processes which more or less remotely resem- 
ble the processes of nerve cells and which form synapes either with 
nerve cells or their processes. They may be regarded as an intermediate 
step between epithelial cells and true nerve cells. As has already been 
stated the central nervous system is of epithelial origin. A careful 
study of its ultimate constituents shows to what a marvelous exent the 
embryonic epithelial cells are capable of modification. 

The nasal cavity is first represented by two epithelial invaginations. 
At an early period these epithelial cords become hollow and are at first 
known as the nasal pits. The epithelial invasion continues until it finally 
reaches the mouth cavity and the pits finally become tubes which open 
into the mouth. Soon after the opening into the mouth is established, 
the hard palate begins its development and as this progresses backwards 
the openings of the nostrils into the mouth are carried back until they 
open into the pharynx, a condition permanent in the adult. Soon after 
the development of the nostrils a differentiation of the cells of the regio 
olfactoria occurs and as a result of this certain of the epithelial cells 
develop into neuro-epithelium and these constitute the cells of special 
sense of the nose. In the portion of the nose nearest the external orifice, 
there are numerous sebaceous glands which apparently differ in no 
essential respect from other sebaceous glands of the body, either in their 
development, or general structure. Along these sebaceous glands 
numerous short stiff hairs are found. The vomero-nasal organs are 
developed in the lower external portion of the epithelial covering of 
the vomer bone. These are sometimes known as Jacobson's organs. 
They are never of functional importance either in the human being or 
any of the other mammals. In a mouse these organs are clearly dis- 
tinguishable shortly after the formation of the nasal pits. Like the nos- 
trils themselves, these organs begin as invaginations of epithelial cells, 
and it is questionable whether they ever advance much beyond this stage 
of development in the mammals. 

HAIR AND TEETH. 

There is considerable similarity between the development of the hair 
and the teeth. In both cases epithelium and connective tissue enter 
into their structure. In the case of the hair, the connective tissue does 
not extend beyond the general surface of the body, while the greater 



DEVELOPMENT OF THE EPITHELIAL ORGANS 179 

portion of the external tooth is composed of this tissue. The epithelial 
portions of both begin as a thickening which as a solid cord invades the 
connective tissue. At an early stage of development the developing hair 
or tooth closely resembles the early stage of a gland ; indeed, so far as 
the hair is concerned, the sebaceous glands do bud off from this primary 
epithelial invasion. As the epithelial cord of the hair grows downward, 
the upward development of connective tissue is taking place, but before 
the downward growth meets the upward growth, the ingrowing epi- 
thelium has become cup-shaped at the end and thus fits over the up- 
ward growth of the connective tissue. The combination of these two 
forms the so-called root of the hair. The shaft of the hair which after- 
wards grows out is formed from the epithelial portion of the root. The 
epithelial invasion connected with tooth formation furnishes the basis 
from which is formed the enamel of these organs. The downward 
growth in many respects, as before stated, is comparable to the epithe- 
lial growth which forms a portion of the hair, and the connective tissue 
of the tooth which eventually forms the dentine is quite comparable to 
the connective tissue portion of the hair. The downward growth of 
the epithelial portion of the tooth becomes distinctly divided into two 
parts with more or less evident trace of a third part. The portion first 
developed becomes the enamel of the milk teeth, the second part be- 
comes the enamel of the permanent teeth, and the third feebly developed 
part may occasionally develop into the enamel of a third set of teeth. 
No epithelial cells of the body are more profoundly modified than are 
the epithelial cells which form the hair and the enamel of the teeth, 
and of these, the epithelial cells forming the enamel undergo the great- 
est modification. 

PHOSPHORESCENCE. 

Phosphorescence is a phenomenon characteristic of some members 
of both the animal and vegetable kingdoms. It is by no means certain 
that it is produced in all cases in the same way. It appears that among 
certain of the protozoa phosphorescence results from the production of 
some substance which undergoes oxidation upon contact with the air, 
and it is quite possible that it is in this way that the phosphorescence of 
fish is produced. The phosphorescent organs of the toad-fish consist 
of epithelial invaginations. The cells do not present any very marked 
structural characteristics, which leads to the suspicion that it is rather 
a physiological activity of the cell than a histological characteristic. 



180 SCIENTIFIC INVESTIGATIONS 

However, much more work must be done along this line before any- 
positive assertion can be made. 

GERMINAL EPITHELIUM. 

The origin of the germinal epithelium of the vertebrates is wrapped 
in almost complete obscurity. All recorded observations up to the pres- 
ent time appear to indicate that it is of mesoblastic origin and at an 
early stage of development it differs in no observable respect from other 
portions of the peritoneum of which it forms a part. The first evidence 
of differentiation is observed when the squamous cells of that portion 
of the peritoneum which covers the genital ridge develop into columnar 
cells. Shortly after these cells assume their columnar form some of 
them proliferate rapidly and form solid cords of epithelial cells which 
penetrate the connective tissue of the reproductive glands. Up to this 
point no differentiation has occurred between the ovary and testis, but 
from this time on a marked difference is observed in their method of 
development. The solid cord of epithelial cells which has penetrated 
the ovary becomes tubular and the lower end enlarges. By the degener- 
ation and absorption of the epithelial cells between this enlargement 
and the surface the lower portion becomes cut off and proceeds with its 
development as a grafhan follicle. The subsequent history of the follicle 
is so thoroughly described in good works on histology that it seems use- 
less to repeat it in this place. The solid cords which penetrate the testis 
also develop into tubes, but unlike the tubes of the ovary, they are per- 
manent and the outer ends of these tubes eventually become continuous 
with some of the tubes of the degenerating Wolffian body and so 
through these and the Wolffian duct, which is now known as the vas 
deferens, the testis has a permanent outlet. Little or no enlargement 
occurs at the lower ends of the tubules in the testis at the place where the 
graffian folicle is developed in the ovary, but it is in a corresponding 
place in the testis that the spermatozoa are produced. In spite of all 
the careful work which has been done by the closest observers and most 
competent histologists, the complete histogenesis of these cells is very 
unsatisfactorily explained. It seems quite probable that they are the 
direct descendants of the germinal epithelial cells which form the origi- 
nal invagination of the gland. 



CASE OF SPLENO-MEDULLARY LEUKEMIA 181 



*A CASE OF SPLENO-MEDULLARY LEUKEMIA. 

There is no lack of medical literature relating to leukemia, but as 
very few cases have been discussed by osteopaths, a little more litera- 
ture upon the subject seems justifiable. 

Leukemia is one of several diseases whose most evident manifes- 
tation is an abnormal condition of the blood. This is so characteristic 
that our best authorities are quite agreed that a critical blood examina- 
tion is the only method whereby it may be distinguished from several 
other diseases. Although all of the anemias vary widely from the leuke- 
mias in their nature and etiology, still the only positive means of distin- 
guishing between them, especially at an early period, is by a careful 
study of the blood. Two well-defined types of leukemia are recognized, 
one being that which forms the heading of the present article and the 
other the lymphatic type. The latter is characterized by a pathological 
condition of the lymphatic glands and by an abnormal condition of the 
blood, the chief characteristic of which is a vastly increased number of 
lymphocytes. As I have never met with a case of this kind, I have no 
basis for any discussion of this form of the disease and so I proceed at 
once with the case in hand. 

The physical examination of a patient, who was recently brought 
to the clinic of the Pacific College of Osteopathy for examination, show- 
ed a young man of about twenty years of age, of medium height and 
light complexion. The spleen was greatly increased in size and extended 
not only clear across the abdomen but as low as the pubic bone. He was 
able to walk without any special inconvenience, though he soon became 
exhausted. His pulse and temperature were both nearly normal. 

During the time that he remained in the clinic ; i. e., from Jan. 22d 
to Feb. 14th, the pulse varied from 87 to 106 and the temperature varied 
from 97.3 to 104. During all of this time his respiration, during a per- 
iod of inactivity, remained at about 30 in a minute. He was subject 
to more or less headache, although his suffering was by no means severe 
nor constant. He complained on a few occasions of feeling dizzy on 
rising quickly from either a chair or bed. 

While under treatment the spleen was appreciably reduced in size. 
It is probable that some cardiac disturbance from which he occasion- 
ally suffered was due to this dimunition in size. Between the time of 
his entrance to the clinic — Jan. 22d, and the time he left, Feb. 14th — 

*Jour. A. O. A., July, 1906. 



182 SCIENTIFIC INVESTIGATIONS 

I made six careful examinations of his blood. I give the results of 
these examinations, as they show, among other things, the importance 
of repeated examinations in these cases. While each examination is 
indicative of spleno-medullary leukemia, it will be seen that there is 
a wide variation in comparatively short periods of time, and had any 
one of these examinations been the only one made, erroneous conclu- 
sions as to real condition of the patient might have been drawn. Both 
the etiology and nature of leukemia are obscure and the indications are 
that considerable time will elapse before this obscurity shall all be 
cleared away. The obscurity is due, in part at any rate, to the extreme 
difficulty of securing the necessary post-mortem material to enable one 
to complete the study which he may begin during the life of the patient. 
This difficulty is accentuated by the fact that there is no known method 
of inducing the disease in animals and that while some species of animals 
may be more or less subject to the disease, it is generally not recog- 
nized until they are about to die, even if it is at that time. 

It is clearly established that both the spleen and the red marrow 
of the long bones are affected to a marked degree in leukemia and re- 
ports seem to indicate that the liver also is almost invariably more or 
less affected. Some pathologists have regarded the abnormal condi- 
tions of these organs as being secondary to the condition which is al- 
ways present in the blood. Those who hold this view regard this 
disease as distinctly a blood tumor and they homologize this with 
other tumors by regarding the leucocytes as true blood cells and the 
liquid portion of the blood as the matrix of these cells. The enormously 
increased number of leucocytes and abnormal nucleated cells found in 
the blood are regarded as the equivalents of the infiltrated cells found 
in the connective tissue in carcinoma. This hypothesis is a rather 
attractive one but is subject to two serious objections. The first is that 
blood does not constitute a tissue as the term is generally used by his- 
tologists. The relationship between the blood cells and plasma is 
totally different from the relationship between cartilage cells and their 
matrix inasmuch as the matrix cartilage is derived from the activity of 
the cells, while the plasma of the blood is not formed by the blood cells. 
The second objection is that in all tumors formed by infiltration there 
are large numbers of dividing cells to be found during the period of 
rapid growth, but in leukemia dividing cells in the blood are not al- 
ways numerous. In the present case of leukemia, I made a particularly 
careful search for dividing cells, but found very few, not many more 
than might be found in perfectly normal blood. 



CASE OF SPLENO-MEDULLARY LEUKEMIA 183 

I here present the results of the several counts and the dates upon 
which they were made. Each count was made at least four and a half 
hours after the last meal. 

Jan. 25th, erythrocytes 3,120,000, leucocytes 503,600, poikilocytes 
280,000, myelocytes 1D6,000. 

Jan. 27, hemoglobin 30 per cent., leucocytes 487,800, myelocytes 
80,000. 

Feb. 1st., leucocytes 501,200, myelocytes 104,000. 

Feb 6th, hemoglobin 30 per cent., leucocytes 146,400. 

Feb. 8th, hemoglobin 35 per cent., erythrocytes 3,256,000, color 
index 54, leucocytes 546,000, megaloblasts 32,000, normoblasts 20,000, 
myelocytes 256,000. 

Feb. 15th, leucocytes 489,600, megaloblasts 127,200, normoblasts 
5,600, myelocytes, 127,200. 

The four or five kinds of leucocytes found in normal blood are 
also found in the blood of persons suffering from leukemia, but in ad- 
dition of these there are a varying number of abnormal cells found, 
most of which are more or less nearly related to the leucocytes. 

In the preceding report I have classed myelocytes with leucocytes 
and poikilocytes with erythrocytes. The classification of blood elements 
which I have used in this article is by no means satisfactory, but neither 
a convenient nor a logical classification has yet been proposed. The 
classification used by most haematologists is based in part upon the 
supposed origin of the cells, those produced in the lymphatic glands 
— lymphocytes — and those produced in the spleen and bone marrow 
— polymorphonuclear leucocytes, mononuclear leucocytes, transitional 
leucocytes; in part upon the character of the nucleus as indicated by 
the names just used, and in part upon the staining reaction of the 
several kinds of granules which the cell may contain — neutrophiles, eosi- 
nophils and basophiles. It seems unnecessary to comment on the im- 
perfection of a classification based upon these three-fold character- 
istics. 

In the differential counting I made use of the "Triple Stain" and 
the eosinate of methylene blue. 

The terminology of blood work has grown to such proportions and 
there are so many synonyms that I venture to define the more important 
terms which I have used in this article. Leucocyte is a general term 
used to include all of the white blood corpuscles as well as the myelo- 
cytes. The latter are large blood cells derived from the bone marrow 
and are very seldom in normal blood. They are probably polymorpho- 



184 SCIENTIFIC INVESTIGATIONS 

nuclear neutrophile cells in an early stage of development. The myelo- 
cytes vary widely in size but the average diameter is a little more than 
twice the diameter of an average erythrocyte or red blood corpuscle. 
The large and small lymphocytes differ chiefly in size. Both are de- 
rived from the lymphatic glands, and in each the mucleus is nearly as 
large as the entire cell. The small lymphocyte is about as large as an 
erythrocyte, while the large lymphocyte is somewhat less than twice 
this size. The mononuclear leucocytes closely resemble the large lym- 
phocytes, both in size and in their staining reaction. The polomorpho- 
nuclear leucocytes are about the same in size as the mononuclears, but 
the nucleus is subject to wide variations in form and size. The more 
common form of the nucleus resemble either the crescent, the horse-shoe, 
or the capital letters E. S. or Z. The poikilocytes are fragmentary and 
degenerate erythrocytes, very common in anemia, and by no means un- 
common in leukemia. The megaloblasts are never found in the normal 
adult blood. They are about one-third larger than the myelocytes and 
the nucleus is large, filling most of the cell. The normoblasts are found 
in the red bone marrow or normal individuals and may be found in the 
blood after a severe hemorrhage or in those who are recovering from 
anemia, leukemia or any disease which has seriously depleted the blood. 
The patient who furnished the basis of this article was not able 
to remain in the clinic long enough to make any prediction of the ulti- 
mate effect of osteopathic treatment possible, but during the few weeks 
he was under treatment, he unquestionably made marked improvement, 
so far as the size of his spleen and general symptoms were concerned. 



It is undoubtedly true that much of our work — yes, even our good 
work — is done without the physician clearly understanding the precise 
object for which he is working. It is a matter of the most vital moment 
to the future of osteopathy that we shall be more accurate in the tests 
which we apply to the work which we do. It is not enough from a 
scientific standpoint to simply announce that we "treated" a patient 
and that the patient recovered. The deeper problems relating to the 
human body should interest us more than they do and the questions 
relating to public health should be more generally discussed than has 
been our practice in the past. 



HYDATID MOLE 185 



*A HYDATID MOLE. 

Some time ago a very rare and interesting neoplasm was placed 
in my hands for examination. The clinical aspect of the case in brief 
outline is as follows : 

The patient was a woman not far from forty years of age. She 
was without children, although a miscarriage was reported early in her 
married life. She was not conscious of having been pregnant after this, 
though the presence of this mole gave positive indication that she had 
been. She was of a nervous, billious temperament and was a student 
of far more than ordinary merit. She had been seriously sick for two 
months or more before the expulsion of this mole. The expulsion of 
the mole was sudden and wholly unexpected. It was accompanied by 
almost unendurable pain and violent hemorrhage. Her life was saved 
only after a severe struggle. Her convalescence after the expulsion of 
the mole was rapid and there seems to be no reason at the present time 
for doubting that the recovery is complete. 

The growth unquestionably belongs to that class of neoplasms 
known as the hydatid mole, or hydatidiform mole. These growths 
are extremely rare and statistics show that when patients suffer from 
them, death is a very common result. It is probable that they always 
originate from an abortive pregnancy, but it is equally certain that a 
long period of time may elapse between the death and expulsion or 
absorption of the fetus and the development of the tumor. 

The laboratory examination of the mass revealed a neoplasm 
weighing about two pounds and roughly appearing like a large mass of 
white grapes varying in size from millet seeds to small walnuts. The 
grape-like masses, when examined, were found to be cysts developed 
on the ends of the chorionic villi. The fluid found inside of them was 
not quite so liquid as is the amniotic fluid and was much less dense 
than Wharton's jelly. In this particular case a chemical analysis 
showed the presence of about one-half of one per cent, of albumin and 
nearly two per cent, of sugar. Phosphates and chlorides were present 
in strong traces. The entire mass was rather larger than a quart cup. 

As a general thing the hydatid mole develops early in pregnancy, 
seldom before the first month and usually not later than the fourth 
month. If it develops early the fetus almost invariably dies ; if it de- 
velops later there is a possibility of the fetus's living to complete its 

*Jour. A. O. A., June, 1911. 



186 SCIENTIFIC INVESTIGATIONS 

development. As before stated, it seems certain that pregnancy is 
absolutely necessary for the formation of one of these strange growths, 
for in every case so far analyzed it appears that chorionic villi consti- 
tute their foundation. 

In all of the grape-like cysts which were subjected to a particularly 
careful examination, delicate connective tissue fibres were found in the 
vesicles, and in every case where a careful examination was made the 
vesicles had a well-defined epithelial covering. A number of cases have 
been recorded where the epithelial cells have destroyed the connective 
tissue of the uterine wall and have gotten into blood vessels and have 
thus been carried to other parts of the body where metastatic growths 
have been developed. The arteries in many of the villi in this case were 
found to be partially degenerated. In some of the cases reported the 
growth is so closely united with the uterus that its total expulsion is al- 
most impossible. 

Hydatid moles are by no means easy of diagnosis. In a thin sub- 
ject they may be palpated with some degree of accuracy. Where this 
cannot be done, positive diagnosis may be impossible. If an unusually 
rapid enlargement of the uterus occurs in early pregnancy and this en- 
largement is accompanied by severe hemorrhage there may be reason 
to suspect a growth of this kind. 

These moles are much more common in patients somewhat ad- 
vanced in years than in young people. Patients who suffer from malig- 
nant growths upon some other part of the body are somewhat more 
likely to develop growths of this kind. 

In the early stages of development the embryo becomes surrounded 
not only by the amnion, but by a membrane developed from the 
amnion which encloses the amnion itself and which is known 
as the chorion. The chorion consists of two distinct germinal 
layers, the outer layer being of epiblastic origin and the inner layer 
being derived from the somatopleuric layer of the mesoblast. The 
outside epiblastic layer soon divides into two reasonably well-defined 
layers, the outer one of which is known as the syncytium and the inner 
one, composed of large well-defined cells, known as the cells of Lang- 
hans. Cells of both of these layers push into the decidua basalis in the 
form of solid cords. At a later time the mesoblast which is rich in 
blood vessels, grows into these epithelial cords. When it is remem- 
bered that the blood vessels of the mesoblast extend from the embryo it 
will readily be seen how it is that the embryo becomes connected with 
the chorionic villi. This connection is precisely the same whether the 



HYDATID MOLE 187 

villi undergo normal development or whether they become cystic. These 
membranes enclosing the fetus are themselves completely enclosed by 
the decidua reflexa of the uterus. During the later stages of pregnancy 
the decidua reflexa is normally absorbed but the decidua basalis against 
which the fetus and its membranes are resting, develops into the mater- 
nal part of the placenta. These villi are at first formed over the entire 
surface of the chorion and this appears to be the permanent condition 
in the horse and other closely-related animals, but in the human being 
these villi are of comparatively short duration except in one dish-shaped 
area which ultimately develops into the placenta. Ordinarily these 
villi persist during the entire period of pregnancy and it is from the 
blood vessels of these villi that the fetus gets its nourishment. If for 
any reason the fetus perishes these villi, as a general thing, quickly lose 
their vitality and are either expelled or become absorbed, but it occasion- 
ally happens that the death of the fetus is not attended by the death of 
the chorionic villi which may, when no longer controlled by the fetus, 
rush on into lawless and irregular development. 

This development may assume any one of the several forms of 
which I now speak. The epithelial calls may rapidly multiply without 
attaining full development. When this occurs we have a primary 
uterine cancer. It is quite possible that many uterine cancers originate 
in this way. It may happen that the villi undergo cystic degeneration 
in which case we have such a growth as I have attempted to describe 
here. There is always a possibility of the epithelial cells on the outside 
of the cyst springing into unwonted activity. If the mole is not com- 
pletely removed and these external epithelial cells proceed to rapid mul- 
tiplication a cancer may follow a well-recognized cyst. Indeed, it is 
by no means rare for a hydatid mole to be followed by a cancer. 

Another danger, against which the physician must be on his guard, 
is that of infection following the expulsion of the mole. The safety of 
the patient demands not only that the mole be removed in its entirety, 
but that every precaution be taken to prevent the entrance of bacteria 
into the uterus when the uterus is in such a poor condition to resist 
infection. 



188 SCIENTIFIC INVESTIGATIONS 



*SOME COMMON ABNORMALITIES OF THE UTERUS. 

The normal structure of the uterus is different from that of any- 
other organ in the human body. The outer or serous coat and the thick 
muscular wall may be passed over with little comment. The simple epi- 
thelial lining is not strikingly at variance with other epithelium. But be- 
tween the muscular wall and the mucous lining is a most interesting 
layer of tissue which is sometimes known as the uterine stroma. 

The stroma is composed of much branched cells forming a tissue 
of a comparatively loose nature. Among these cells composing the 
stroma are a varying number of cells closely resembling leucocytes. 
It is an open question with histologists and embryologists as to whether 
the cells of the stroma are more nearly related to epithelial cells or to 
connective tissue cells. From a practical standpoint, the question is not 
one of especial importance. 

One of the comparatively common abnormalities of the uterus is 
the excessive development of the connective tissue cells which support 
the cells forming the muscular wall. If this excessive development of 
connective tissue is immediately underneath the peritoneal covering of 
the uterus, it is spoken of as a subperitoneal fibroma. If the excessive 
development is in the wall of the uterus, it is spoken of as a mural 
fibroma. If the development is immediately underneath the stroma, its 
growth carries it into the cavity of the uterus and we have a sub-epithe- 
lial fibroma. Fibromas of the latter type are frequently extremely vas- 
cular and when this is the case and when the fibroma in its inward 
growth becomes more or less pedunculated, we then have a uterine 
polyp from which there may be a varying amount of hemorrhage. The 
extent to which the patient may suffer from hemorrhage is subject to 
great variation. It may amount to very little or it may be so excessive 
as to seriously threaten the life of the patient. 

Almost all that has been said in regard to the possibility of ex- 
cessive growth of connective tissue cells forming fibromas may also 
be said of the non-striated muscle cells. When this is the case, the 
tumor is known as a myoma. In most of the cases which have come 
under my observations, the growth consists of a mixture of connective 
tissue cells and muscular cells constituting what is known as a fibro- 
myoma. These growths in and of themselves are never malignant, 

*Read before Section in Gynecology and Obstetrics at Chicago meeting of the Am. 
Ost. Ass'n., July, 1911. Pub. A.O.A. Jour., Feb., 1912. 



COMMON ABNORMALITIES OF UTERUS 189 

although, as has been pointed out, they may be, from their tendency to 
produce hemorrhage, more or less dangerous to the health and even 
to the life of the patient. 

It is not rare to find a patient suffering from an excessive epithe- 
lial growth in the uterus. Under normal conditions, the entire inner 
surface of the uterus is more or less glandular. Sometimes the cells 
in these glands begin an unusual lawless growth and the glands be- 
come enormously enlarged and extended. As long as this growth pro- 
duces parts which may be functional, we simply have a hypertrophied 
gland, but when the glandular epithelial cells are carried far into the 
substance of the uterus and when they cease to have such an arrange- 
ment as makes it possible for them to function as gland cells, we then 
have an adenoma. 

Adenomas of small size are by no means unusual. Like the myoma 
and fibroma, the adenoma is a benign growth, but like all other abnor- 
mal growths, it is more or less of a menace to the health and even to 
the life of the patient. As the adenoma is developed from non-vascular 
tissue, there is little danger of its resulting in hemorrhage, but it is by 
no means unusual for the epithelial cells forming the adenoma to give 
rise to epithelial cells which are still more lawless and which break 
through the basement membrane which normally restrains all epithelial 
cells and thus begin an invasion of the connective and muscular tissue 
of the uterus. When this is the case, we have the beginning of a car- 
cinoma. 

This malignant growth once started may develop either slowly or 
rapidly. It certainly appears in many cases that the development is slow 
and while it may occasion more or less suffering, it may not materially 
shorten the life of the patient. On the other hand, the development 
may be so rapid in character as to present a most serious problem, both 
to the physician and the surgeon. 

It would not be proper to close a paper of this character without 
calling attention to the increasing importance which the endothelial cells 
of capillary blood vessels are assuming in the minds of the best patholo- 
gists. It is barely possible that many abnormal growths which have 
been attributed either to epithelial, muscular or connective tissue cells 
may have arisen from the endothelial cells of capillary blood vessels. 
Should further investigation prove this to be the case, it would be a 
reason for our attaching even more significance to circulation than we 
do at the present time. 



190 SCIENTIFIC INVESTIGATIONS 



-SOME EXPERIMENTS WITH THE OPSONIC INDEX. 

During the years 1909 and 1910, I made a series of careful ex- 
periments to determine whether or not it was possible to affect the 
opsonic index of an individual by mechanical manipulation. This 
series of experiments was made upon myself, the report forwarded to 
the Research Institute and published in its first bulletin. 

During the years 1910 and 1911 I made another series of experi- 
ments. Some of these were made upon a person known to be the vic- 
tim of chronic tuberculosis ; others were made upon persons supposed 
to be entirely free from tubercular taint. As this report may possibly 
be made the basis for other work, I present my results in tabulated 
form and give a brief description of my methods, so that every one 
may be in a position to judge of the value of the work. 

In every case I used the leucocytes from my own blood. I ob- 
tained blood serum from the person who was to be experimented upon 
and determined the opsonizing power of this serum. The person was 
then placed upon a table and the splanchnic area of the back was 
highly stimulated. The subject was then placed on his back and direct 
and heavy stimulation was applied over the region of the liver. The 
whole process of stimulation occupied perhaps twenty minutes of time. 

From half an hour to two hours after this stimulation, blood was 
again drawn from the patient and its serum separated from it. The 
test was of course made by comparing the opsonizing power of the 
serum obtained before the stimulation with the serum obtained after 
the stimulation. 

The first person experimented on was Miss L., who is a victim 
of chronic tuberculosis. The experiments were made by taking her 
serum and then subjecting her to stimulation as already described and 
after the stimulation again taking blood from which the serum was 
obtained. 

The chief value, as I understand it, which centers around this 
work, lies in the fact that phagocytosis appears to be greatly increased 
by mechanical manipulation. It shows that in the cases reported upon 
the susceptibility of the individual to tubercular infection was greatly 
decreased by mechanical stimulation. If further experimentation shall 

*Read before Research Institute Session, Chicago meeting of the Am. Ost. Ass'n., 
1911. Pub. Jour. A. O. A., July, 1912. 



EXPERIMENTS WITH THE OPSONIC INDEX 



191 



show that this specific fact is a general truth, if it should be found that 
phagocytosis toward all bacteria is increased by mechanical stimula- 
tion, then we certainly have in mechanical stimulation a prophylactic 
measure which is much more valuable than prophylactic antitoxins 
have ever been supposed to be, even by those who had most faith in 
them. The tabulated results were as follows : 



DATE 



From the influence of serum 
taken before stimulation 



Leucocytes 
counted 



Bacteria 
ingested 



From the influence of 
taken after stimulation 



Leucocyte 

counted 



Bacteria 
ingested 



Opsonic Index 

after stimulation 

compared with 

Index before 

stimulation 



Percentage 
of gain 

by stimu- 
lation 









MISS L. 








March 17 


50 


151 


50 


163 


107.9 


7.9 


March 24 


80 


334 


80 


407 


121.8 


21.8 


April 7 


85 


257 


85 


283 


110.1 


10.1 


April 14 


75 


312 


75 


354 


113.4 


13.4 


April 21 


50 


116 


50 


132 


113.7 


13.7 


Average 












. . . 13.4 






MR. W. 








April 28 


50 


211 


50 


253 


119.9 


14.7 


May 5 


80 


402 


80 


463 


115.1 


15.1 


May 12 


100 


287 


100 


315 


109.8 


9.8 


May 19 
Average 


80 


227 


80 


242 


106.6 


6.6 
...11.5 



I suspect more strongly each year that our ultimate conclusion will 
be that it is not good practice to ever introduce into the human body 
any substance which is not a normal constituent of the body and that 
whatever we do, either in the way of prophylaxis or in the way of 
treating disease, should be done in the way of aiding and stimulating 
nature, rather than in supplementing her efforts by outside and un- 
natural forces. 

All of the work which has been done during the last few years 
which throws more light upon the human body, impresses us with the 
supreme importance of the normal structure of the body. To the edu- 
cated biologist, normal function without normal structure is simply 
inconceivable. Not only must the structure of organs be normal, but 
organs must be in normal relationship to each other. 

One cannot contemplate the results recorded here without the 



192 SCIENTIFIC INVESTIGATIONS 

question arising as to how they have been produced- Several possible 
answers readily present themselves. It may be due to simply merg- 
ing blood pressure; it may be due to having increased the elimination 
from the body ; it may be due to having caused more rapid oxidation. 

Another question which I have not solved, but which is of great 
practical importance, is in regard to the length of time this increased 
opsonic index lasts. It will readily be seen that if prophylactic use is 
to be made of physical manipulation, the physician should have some 
clear idea as to how frequently his treatment should be administered. 

YVe are as yet wholly ignorant of the origin of the opsonins. It is 
not improbable that when we shall definitely know where they origi- 
nate, we may by direct stimulation of the organ or organs producing 
them be able to increase them much more rapidly and more certainly 
than we now can, while we are working entirely in the dark. 

In a report of this kind, there is little room for speculation, but 
I may, perhaps, be pardoned for suggesting, not the possibility but the 
strong probability, that the opsonic index is materially lowered both 
by bony lesions and by muscular contractions. 

Records of forty-four cases treated in the clinic of the Pacific 
College of Osteopathy have been studied in this connection. Of these. 
the anterior interscapular spine was associated with the posterior lower 
dorsal and upper lumbar in thirty-seven cases. In one case the upper 
dorsal spine was decidedly posterior and the lumbar curve was exag- 
gerated. In one other case the curves were fairly normal and the spinal 
lesions consisted chiefly of a lack of mobility* throughout. Both of 
these cases were of fibroid phthisis, and the disease has been present 
for many years. These cases include pulmonary, laryngeal, hip and 
knee, omentum and kidney tuberculosis, tubercular lymphatics and 
arthritis. Pott's disease was not included. 

The spinal outline characteristic of tuberculosis and of the pre- 
tubercular stages presents the following peculiarities: The cervical 
spine presents various abnormalities, usually lesions involving single 
vertebrae and associated with irregular muscular tensions. The upper 
thoracic spine is anterior, the ribs drooping and rather more freely 
movable than normal ; the vertebral articulations are less movable than 
normal; the tissues in the neighborhood of the upper two or three 
dorsal spines are abnormally sensitive and the muscles innervated from 
these segments are contracted irregularly when the disease involves 
the apices. The lower interscapular region is found sensitive and 
these muscles are contracted when the lower lobes of the lung are in- 



OBSERVATIONS ON A FETAL CALF 193 

volved, and the location of these sensitive areas may be employed in 
the localization of the lung area infected. 

In every case recorded in this clinic, lesions involving the area of 
the origin of the upper and middle splanchnic nerves have been found. 
The typical tuberculosis spine must include lesions of the lower dorsal 
area. Probably these lesions are predisposing factors in tuberculosis, 
partly because of the effects produced upon nutrition thereby, but 
doubtless the lack of the normal mobility of this part of the spine pre- 
vents the normal stimulation of the liver, thus the normal opsonic in- 
dex is lost, and immunity broken. The treatment of tubercular cases 
should include careful attention to the splanchnic area, the maintenance 
of the normal mobility and structural relationship of the entire spinal 
column, and such stimulating movements to the ninth and tenth thor- 
acic neighborhood as is indicated in each individual case. 

Osteopathic physicians and investigators are the only scientists 
now working on bony lesions and muscular contractions as related to 
the etiology of disease. There is no lack of competent investigators 
who are working on the body serums and on the problems of bacteri- 
ology in general. Just now it seems to be our special business to in- 
vestigate the effect of bony lesions and muscular contractions upon the 
body, not only in the somewhat superficial way in which it has been 
done in the past, but to study the effect of these conditions upon the 
metabolism and the blood-and-lymph-forming organs of the body. 



^OBSERVATIONS ON A FETAL CALF. 

On the second day of June of the present year I was making a 
close examination of a fetal calf of perhaps six months' advancement. 
The Amnion was intact and the calf still floated in the Amniotic fluid. 
I distinctly saw it swallow three times in succession, and on opening 
its stomach I found at least twenty c.c. of Amniotic liquor present. In 
this epithelial cells and hairs were plentiful. I have found scales, hairs, 
etc., in the stomach of fetal calves, lambs and cats, and it is possible 
that the fetus derives an appreciable amount of nourishment from the 
fluid thus swallowed. 

The subject is worthy of careful and extended investigation. 



r The Osteopath, P. S. O., July, 1900. 



194 SCIENTIFIC INVESTIGATIONS 



^INVESTIGATIONS OF THE PHAGOCYTIC INDEX. 

During the winter of 1911-12, I began a series of investigations 
for the purpose of determining how long the opsonic index is affected 
by mechanical manipulation. It will be remembered that as early as 
1884, Mechnikoff discovered the fact that the white blood corpuscles 
possess the power of destroying many bacteria as they enter the tis- 
sues of the body. For a number of years it was supposed that this 
was the only defensive measure which the body employed against the 
invasion of parasites ; but at a later time, it was found that when para- 
sitic invaders enter the body, a response is made to them, not only by 
the phagocytes which devour them, but that specific substances were 
produced in the blood, which dissolved them. These substances were 
called lysins ; and soon after this discovery, it was shown that another 
class of bodies was produced, which are known as agglutinins, the 
function of this latter substance being to cause bacteria to adhere to 
each other until they form large masses or clumps. The next discov- 
ery was one of great practical importance, and was that phagocytosis 
is largely dependent upon bacteria being acted upon by substances pro- 
duced in the blood, which are called opsonins. Careful experiments 
showed that unless the bacteria were acted upon by opsonins, they were 
not very readily destroyed by the phagocytes. It was also shown that 
the opsonins in the blood may be produced as a result of stimulation 
by bacterial toxins, contained within the bodies of the bacteria, and 
from this discovery arose the important practice of vaccine therapy. 

Somewhat more than two years ago, I discovered, as a result of 
considerable experimentation, that mechanical stimulation of the liver 
and spleen, would also increase the opsonins in the blood; at least, so 
far as the opsonins acting upon the bacilli of tuberculosis are concerned. 
A few experiments and some clinical experience seemed to indicate 
that this was also true of other bacteria. If it is indeed true that the 
opsonins are increased by liver and spleen stimulation, it is a most im- 
portant fact; for it is highly improbable that the vaccine methods can 
be used without inflicting more or less injury upon the organism. I 
believe it is a biological truth that no substance should ever be intro- 
duced into a living organism, which cannot, by digestion and assimila- 
tion, become a constituent part of that organism. 

The last experiments which I made and the results of which I 

*Jour. A. O. A., Sept., 1912. 



INVESTIGATIONS OF PHAGOCYTIC INDEX 195 

append to this article, were made for the purpose of determining how 
long the increase of opsonins lasted after stimulation. As these ex- 
periments were made during the session of The Pacific College of 
Osteopathy, it was impossible to work with any considerable number 
of people, as the same individual must be accessible for a number of 
hours in succession. These experiments were conducted upon one 
man and one woman, both being, so far as known, in perfect health. 
The technic of the work was as follows : 

technic. 

Before any stimulation, the power of the leukocytes to destroy 
the bacilli of tuberculosis was determined. All of these experiments 
were based upon a count of 100 leukocytes and the average number 
of bacilli which these leukocytes were able to ingest, was called the 
phagocytic index. Immediately after this determination was made, 
the subject was subjected to mechanical stimulation of the liver and 
spleen region. At varying intervals of time after this, the phagocytic 
index was determined, with the results shown in these tables. 

It is needless to say that a certain allowance must be made in 
work of this kind for error, and as both of the people experimented 
upon were particularly busy people, the results may have been some- 
what vitiated by their mental and physical activity. It will be observed 
that the effects of stimulation disappeared in between four and six 
hours. If further experimentation shall show that this is universally 
the case, Ave have here a key to the length of time which should elapse 
between osteopathic treatments in cases of acute diseases. It is with 
no inconsiderable hesitation that I present these fragmentary and in- 
complete results; and it is with full knowledge that further investi- 
gation may show serious fallacies, that I send this matter to the 
printer; but our profession is young, and our research work is in its 
extreme infancy, and perhaps the publication of results, which will 
need careful revision, will do good rather than harm. 

Mr. Y, April 8th, Ipi2. 

Phagocytic Index before stimulation 3.42 

One-half hour after stimulation 4.21 

Two hours after stimulation 4.44 

Three hours after stimulation 3.83 

Four hours after stimulation 3.12 



196 SCIENTIFIC INVESTIGATIONS 

Miss X, April 8th, 1912. 

Phagocytic Index before stimulation 4.23 

One-half hour after stimulation 6.42 

Two hours after stimulation 5.17 

Three hours after stimulation 4.76 

Four hours after stimulation 4.34 

Five hours after stimulation 3.92 

Mr. Y , April pth, 1912. 

Phagocytic Index before stimulation 3.80 

One-half hour after stimulation 3.00 

Two and one-half hours after stimulation 3.10 

Four hours after stimulation 3.40 

Five hours after stimulation 3.40 

Miss X, April 9th, 1912. 

Phagocytic Index before stimulation 5.00 

One-half hour after stimulation 7.30 

Two and one-half hours after stimulation 7.10 

Three and one-half hours after stimulation 6.50 

Mr. Y , April ioth, 1912. 

Phagocytic Index before stimulation 3.50 

Forty-five minutes after stimulation 5.35 

Two hours after stimulation 5.42 

Three hours after stimulation 3.72 

Miss X, April ioth, 19 12. 

Phagocytic Index before stimulation 4.51 

One-half hour after stimulation 5.26 

Two and one-half hours after stimulation 4.64 

Three and one-half hours after stimulation 3.26 

Mr. Y , April nth, 1912. 

Phagocytic Index before stimulation 4.01 

One hour after stimulation 6.02 

Three hours after stimulation 5.23 

Mr. Y , April 12th, 1912. 

Phagocytic Index before stimulation 4.61 

One-half hour after stimulation 6.71 

Two hours after stimulation 5.48 

Three hours after stimulation 372 

Four hours after stimulation 3.91 

Five hours after stimulation 4.67 



EXPERIMENTS WITH DRUGS 197 

Miss X, April 13th, 1912. 

Phagocytic Index before stimulation 4.89 

One hour after stimulation 5.78 

Two hours after stimulation 6.04 

Three hours after stimulation 5.52 

Four hours after stimulation 5.64 

Five hours after stimulation 5.01 

Mr. Y , April 16th, 1912. 

Phagocytic Index before stimulation 4.56 

One-half hour after stimulation 6.87 

Two and one-half hours after stimulation 4.37 

Four hours after stimulation 5.36 

Six hours after stimulation 3.27 

Miss X, April 20th, 1912. 

Phagocytic Index before stimulation 3.85 

One-half hour after stimulation 5.54 

Two and one-half hours after stimulation 4.89 

Four hours after stimulation 4.02 

Five hours after stimulation 4.07 

Six hours after stimulation 3.59 



^EXPERIMENTS WITH DRUGS. 

During the past year I have made a number of experiments in re- 
gard to the effect of drugs commonly used as medicines upon the pro- 
tozoa. In many respects these organisms closely resemble the epi- 
thelial cells of our bodies. In all cases drugs proved fatal to the pro- 
tozoa, even when the first effect seemed to be that of stimulation. These 
experiments have not yet gone far enough to warrant any general or 
far-reaching conclusions, but it is safe to suspect that their effect upon 
the epithelial cells is quite as injurious as is their effect upon the uni- 
cellular animals, and that whatever good may come from their stimu- 
lating effects upon some cells is more than counterbalanced by their 
disastrous influence upon the epithelium of the organs of elimination. 
If this shall prove to be true, there is certainly another good reason 
why the physician should avoid their use. 

*Report given at A. O. A. meeting at Kirksville, 1913. Pub. A. O. A. Jour., Aug., 1913. 



198 SCIENTIFIC INVESTIGATIONS 

*THE PURIN BODIES. 

WHAT ARE THE PURIX BODIES? 

The purin bodies are a group of closely related compounds of 
which uric acid may be taken as a type. The name purin is derived 
from the Latin word purum (pure) and probably refers to the fact 
that purin itself is the mother substance from which all of the so-called 
purin bodies may be derived. Its chemical formula is C5 H4 X4 and 
to this as a nucleus various additions of atoms and radicals may be 
made, resulting in a large number of compounds having a general 
chemical and physiological resemblance to each other. 

The most important purin bodies, so far as the physiologist is con- 
cerned, are hypoxanthin (C5 H4 X4 O.). xanthin (C5 H4 X4 02.). 
uric acid i C5 H4 X4 03.), theobromin | CS H2 C2 H6 X4 02.), caf- 
feine > C5 H4 X4 02 C3 H6.), guanin (C5 H5 X5 O. ). adenin (C5 H4 
X4 XH. ). paraxanthin (C5 H2 C2 H6 X4 02). 

There are hundreds of these related compounds, but the foregoing 
list includes those whose effects upon the human body are best known. 

Hypoxanthin and xanthin are generally found together. They 
occur in urine in small quantities, but they are much more abundant 
in meat extracts. When prepared in a pure state they are in the form 
of a white or slightly grey powder, which is alkaline in reaction and 
which is almost insoluble in water, alcohol and ether. They form 
soluble crystallizable salts with most acids. Uric acid is to a very 
limited extent a normal constituent of mammalian urine. It is the 
chief nitrogenous constituent of the semi-solid urine of reptiles and 
birds. In a pure state uric acid is a white, crystalline., odorless, taste- 
less substance and like xanthin and hypoxanthin is almost insoluble 
in water, alcohol or ether. It requires 15.000 parts of cold water and 
1.900 parts of boiling water to dissolve it. It is needless to say that 
it is sharply acid in reaction. 

Theobromin is not normally found in animal tissues, but is abund- 
ant in the seeds of the theobroma cacao tree, from the seeds of which 
chocolate is made. It is because of its presence in this popular bev- 
erage that it is of interest in this place. Theobromin is a white, crys- 
talline solid, slightly soluble in water, ether and alcohol and it volatil- 
izes at a temperature of 290 degrees C without decomposition. Its 
reaction is neutral, but it forms salts with a number of acids. 



'Jour. A. 0. A.. Aug.. 1905. 



THE PURIX BODIES 199 

Caffeine appears to be identical in composition with theine. Like 
theobromin, it is not found in animal tissue. It is found in the leaves 
of the tea plant and in coffee berries. In a pure state., it crystallizes 
in long, silky needles, soluble in 80 parts of cold water and 33 parts 
of alcohol. It is slightly soluble in ether. Its reaction is neutral. 

Guanin is a white amorphous powder, almost wholly insoluble in 
water, alcohol or ether. It is abundant in Peruvian guano and is found 
in small quantities in the pancreas, liver and muscles of animals. 

Adenin is usually found in the form of flat crystals, with a lustre 
which reminds one of pearl. It is found in the liver and also in the 
urine. It is basic in reaction and forms salts with mineral acids. Both 
guanin and adenin play an important part in the activity of cells. 

Paraxanthin is an isomer of theobromin, which it closely resem- 
bles in its chemical, physical and physiological properties. It is to a 
very slight extent a normal constituent of urine. 

WHAT IS THE PHYSIOLOGICAL EFFECT Or THE PURIX BODIES UPON THE 

HUMAN SYSTEM ' 

The foregoing question is not an easy one to answer. It is prob- 
ably true there is a wide range among individuals in regard to the way 
in which they are affected by the purin compounds. It appears that 
some people are affected very little, probably not to any appreciable 
extent, while others suffer very severely from their inability to excrete 
the purins which are ingested with their food. Physiologists recognize 
two sources of purin in the animal body. One source is the ordinary 
metabolic processes of life. Some of the purin bodies, uric acid, 
xanthin and probably some others, are formed whenever a cell is de- 
stroyed by any vital function. This is especially true of the cells of 
the pancreas, the liver, the thymus and other true glands. Purin which 
results from the natural metabolism of the body is called endogenous 
purin. Experience shows that the endogenous purins are nearly con- 
stant in quantity* while the exogenous purins are subject to wide vari- 
ations. It will be readily noted that while it may be possible for us 
to free ourselves from exogenous purins, we can never free ourselves 
from endogenous purins. 

This is only another of the very numerous instances of the in- 
herent imperfection of the animal body. From the very nature of 
things, no organism can ever develop to a higher state of perfection 
than that which enables it to do its work "well enough.' 1 

Dr. Alexander Haig traces a number of diseases to the presence 



200 SCIENTIFIC INVESTIGATIONS 

in the body of exogenous purins. Among the diseases thus explained by 
him are epilepsy, asthma, gout, Raynaud's disease, rheumatism, Bright's 
disease and a considerable number of others. While it may not be safe 
to accept all of Dr. Haig's views without further investigation, it cer- 
tainly is not safe to reject them until investigation has demonstrated 
their fallacy. Dr. Haig believes that owing to its slight solubility uric 
acid may accumulate in the blood, and that it may assume a colloid form 
which mechanically obstructs the capillaries, thereby raising the blood 
pressure. This form of high blood pressure is indicated when the 
color returns very slowly to the surface of the body after an area 
has been subjected to pressure. 

The name Collemia has been provisionally used to indicate a 
marked excess of colloidal uric acid and urates in the blood. It has 
been known for several years that a copious colloid precipitate will 
be formed whenever a warm saturated solution of urates and sodium 
phosphate is cooled, or when it is rendered acid. This precipitate con- 
sists of a combination of acid-sodium-urate and uric acid. It is quite 
possible that such a precipitation may take place in the body when the 
blood is charged with uric acid or urates, and its alkalinity is tempo- 
rarily- diminished or neutralized by the ingestion of acids. In such 
cases the capillaries of the liver, spleen and other organs of the body 
will at once become clogged with the colloid urates, and an attack of 
gout or some closely allied disease will result. Under these conditions 
the blood is abnormally free from uric acid and urates. Careful ex- 
periments show that a filter saturated with urates will retain urates 
from an acid solution, which is far from being saturated. If a filter 
is partially saturated with common salt, for example, and a partially 
saturated solution of salt is then passed through the filter, the filtrate 
will contain a higher percentage of salt than the original fluid, but 
if the same experiment is tried after substituting a soluble urate for 
the salt and slightly acidifying the solution, the filtrate will contain 
a lower percentage of the urate than the original solution. 

I made a number of experiments which seem to warrant the fore- 
going statement. The determination of the urates was made with 
Ruhemann's uricometer, and the results are probably accurate within 
a narrow limit. In my experiments I used three thicknesses of gray 
German filter paper. I shall present the results of only three cases: 
(a) Urine clear, sp. gr. 1022, slightly acid; uric acid .078 per cent. 
After passing through a thin white filter paper .076 per cent. After 
passing through three filter papers, which were already heavily 



THE PURIN BODIES 201 

charged with urates, .051 per cent. After strongly acidifying with 
acetic acid, the same sample showed only .026 per cent, after similar 
filtration, (b) Urine clear, sp. gr. 1019, slightly acid; uric acid .064 
per cent. After passing through thin filter .061 per cent. After pass- 
ing through three papers, similar to those used in (a), .042 per cent. 
After acidifying with citric acid .021 per cent; acidifying with acetic 
acid .022 per cent, (c) Urine slightly cloudy with phosphates. Alka- 
line, sp. gr. 1017. Uric acid .059 per cent. After filtering through 
thin paper, uric acid .058 per cent. After passing through three papers 
as in (a) and (b), .54 per cent. After acidifying with acetic acid .023 
per cent. It will be noted that the diminution of the urates is almost 
wholly dependent upon their acidity, or what seems to be the same 
thing, upon their being in a colloid state. 

If it is true, as many able physicians suspect, that migraine is 
due to high blood pressure, resulting from collemia, the relief which 
is so frequently experienced from the inhalation of ammonia would 
be easily explained on the ground that by increasing the alkalinity of 
the blood, it made possible the rapid solution of the colloid urates 
which were clogging the capillaries. It would also explain the head- 
ache and the rheumatism and gout which follows the use of wines 
and beers, both of these being more or less acid. It has been sug- 
gested that fatigue which is not the result of hunger, may be due to 
the imperfect nourishment of the tissues owing to the imperfect circu- 
lation due to collemia. 

SOURCES OF THE PURIN BODIES. 

At the risk of some repetition, I now propose briefly considering 
the sources of the purins found in the body. As before stated, some 
are formed in the body as the result of normal metabolism, and are 
known as endogenous purins, while others form a part of the food 
and are known as exogenous purins. The endogenous purins are 
practically constant for the same individual over long periods of time, 
while the exogenous purins are of course subject to constant variation 
with changing diet. It is quite possible that the slight daily variation 
in the endogenous purins may be found to have a periodic rhythm, 
though I believe no investigation up to the present time has established 
this. There seems to be no constant ratio between the excretion of 
the endogenous purins and urea, though in two individuals, I found 
it to run quite constantly between, purin bodies 1 and urea 2, and purin 
bodies 1 and urea 15, but as neither of these persons was well, I do 
not attach much importance to the results. 



202 SCIENTIFIC INVESTIGATIONS 

It is probable that every tissue of the body yields endogenous 
purins as the result of its metabolism, and if this be true, then those 
tissues which are most active would naturally yield the greatest 
amount. Of the several parts of the cell, the nucleins are by far the 
most rich in purins and within narrow limits the amount of endo- 
genous purin found is the measure of nucleins destroyed. 

So far as exogenous purins are concerned, they must be derived 
wholly from proteid foods, as it is obvious that none can come from 
either the carbo-hydrates or the hydro-carbons. The proteids may be 
divided into two groups, those which are practically free from the 
purin nucleus and those in which the nucleus is found. All meats are 
rich in purins, and this is especially true of the glands, like sweet- 
bread (pancreas and thymus), liver, kidney, etc. Peas, pea- 
nuts, beans and oats, among vegetables, are especially rich in the 
purin bodies, containing considerable quantities of xanthin. This is 
true to a lesser degree of asparagus, onions and mushrooms. Careful 
analysis indicates that eggs, cheese, butter and all of the milk pro- 
ducts, as well as fruit and nuts, are relatively free from the purin 
nucleus. The same is true of the various preparations of corn and 
wheat. Tea, coffee and chocolate contain purin abundantly. 

THE PRACTICAL APPLICATION. 

The reader who has had patience to follow me up to this point 
will naturally ask: What practical application can I make of a 
knowledge of the purin bodies? The reply is that we can use all 
knowledge as soon as we know how to use it, but of course we must 
have knowledge before we can reasonably expect to make much use of 
it, and so far as the purin bodies are concerned, we have not by any 
means passed the stage of investigation. Indeed, many investigations, 
demanding time and patience and skill, are yet to be made. It cer- 
tainly seems that even with our present limited knowledge, no thor- 
ough investigation can be made of a patient's metabolism without a 
careful study of his total nitrogen excretion, and this of course in- 
cludes both his urea and his purin output. A study of this kind de- 
mands time and skill on the part of the physician, and his work is made 
more valuable if he knows the normal endogenous purin excretion of 
his patient. If the normal endogenous purin output of the patient is 
known and his diet is accurately known, it is an easy matter to ascer- 
tain whether or not any accumulation of purins is taking place in his 
body. This of course demands an exact knowledge of the percentage 



HEMORRHAGE INTO FETAL SPINAL CORD 203 

of purins in the food used by the patient and the amount of food con- 
sumed, but fortunately, so many analyses of the principal food stuffs 
have been made that it is easy to obtain reliable data. 

The determination of the purin excretion for any single day, or 
even for several days in succession, appears to be of little diagnostic 
importance. The real value of a careful estimation and study of the 
excreted purins will only come when it shall be recognized that it is 
as necessary and important to study an animated machine as it is to 
study an inanimate machine. 



HEMORRHAGE INTO THE FETAL SPINAL CORD. 

A fetus apparently of between five and six months' development 
was sent to the Pacific College for study. 

The nervous system was removed and fixed in 8 per cent, formalin. 
The spinal cord, medulla, pons and midbrain were imbedded in 
paraffine and sectioned. The spinal cord was cut in coronary section, 
the other parts were cross sectioned. All were stained in iron hema- 
toxylin or acid hematoxylin (Erlich). 

In the cord were found many areas or hemorrhage per diapedesis. 
These were large enough to be distinguished with the unaided eye, in 
section. The blood had evidently escaped from the vessels very 
slowly. The neighboring nervous matter had been scarcely disar- 
ranged. The hemorrhagic areas included both the gray and the white 
matter. No hemorrhages were found in the medulla, pons or midbrain. 

According to the statement of the mother, the death of the fetus 
was due to the use of electricity in the hands of a professional 
abortionist. 

A fetus of about the same age, the cause of whose death is un- 
known, shows no evidence of hemorrhages in any part of the nervous 
system. An embryo of about ten weeks, injured by traumatism, shows 
no hemorrhages. 

This report is made because it suggests a possible explanation of 
certain paralyses and mental deficiencies found sometimes in children 
whose intrauterine life had been subjected to risks of attempted abor- 
tion. A further study of embryonic and fetal material is needed, as 
well as more careful study of the histories of defective children. 

*Jour. A. O. A., May, 1911. 



204 SCIENTIFIC INVESTIGATIONS 



*A DERMOID CYST. 

A Dermoid cyst, which was removed from a female patient 47 
years of age, in a hospital in this city, was recently brought to me for 
examination. Its weight was 142 grams, or about 5 ounces, and its 
greatest length was 3iy> cm. (seven inches), its breadth being 7y 
cm. (three inches). The tumor was located in the pelvis and involved 
both the fallopian tube and the ovary, on the right side. The latter 
was enlarged to twenty times its normal size. This enlargement was 
partially due to cysts, enclosing a serous fluid, and in part to the for- 
mation of new tissue. The new tissue was connective tissue composed 
of embryonal cells intermingled with numerous cells of striated mus- 
cular tissue. The tumor consisted of two well denned parts. 

The smaller part, which was about 11 cm. (4^4 inches) long, 
3*/2 cm. {\Yi inches) wide, and \y 2 cm. (24 of an inch) thick, was 
composed of epithelium and connective tissue cells enclosing fatty- 
globules, and detritus resembling disintegrating bone. This mass was 
made coherent by a quantity of long, light colored hair which perme- 
ated every part of it. Some of the hairs were more than two and a 
half feet in length. They appeared to rise in most cases from hair 
follicles, which presented no essential variation in structure from the 
normal type. Among these a few well developed sebaceous glands 
were found. 

The larger part of the tumor was nearly globular in form, about 
6 cm. (2y 2 inches) in diameter and consisted of bone and cartilage as 
well as fibrous connective tissue, and epithelial tissue, enclosing fatty 
detritus. In this portion well developed teeth were found in the epi- 
thelial and osseous tissues. Both incisors and premolars were repre- 
sented in the dentition, and as is very unusual in Dermoid tumors, at 
least one of the incisors belonged to the milk dentition. This was in- 
dicated not only by the size and shape of the tooth, but also by the fact 
that the root had been almost wholly absorbed. Giant cells were found 
in abundance around the root of this tooth. All of the teeth were held 
in place by alveolar processes more or less perfectly developed. Aside 
from the tissues named, all of which belonged to the outer and middle 
germinal layer, there was one piece which somewhat resembled a por- 
tion of an intestine in gross structure, though the minute structure did 
not bear out this interpretation. 

*Bulletin So. Cal. Acad. Sci., Feb., 1905. 



A FEW WORDS ON TUMORS 205 

The origin of dermoid tumors has not yet been satisfactorily ex- 
plained. So far as this particular one is concerned, it is quite possible 
that it was a twin of the patient which for some reason suffered an 
early arrest of development, and which subsequently became enclosed 
in the body of the patient (or twin sister). Here it remained in a 
quiescent condition for years until it was stimulated into a sudden 
growth by some change which affected the metabolism of the patient. 



*A FEW WORDS ON TUMORS. 

The pathologist frequently receives vomitus, pus and various 
kinds of scrapings, for examination, to determine the presence or ab- 
sence of "cancer cells." The laity practically unite in believing that 
cancer cells materially differ from all normal cells, and this belief is 
held by many physicians who have not had careful training along the 
line of structural pathology. 

There are two laws relating to abnormal growths which are the 
keys to all correct thinking and reasoning. The first is that all cells 
of whatever nature found in the body have been derived from pre- 
existing cells, and the second is that the tissue which forms a tumor 
of any kind resembles in its general structure tissue which is normal 
to either the adult or embryonic body. These two statements being 
true, it will readily be seen that it is by no means easy to exactly define 
a tumor, as almost any part of the body is subject to more or less 
hypertrophy or overgrowth. For practical purposes a hypertrophied 
condition means not only an increase of the part in size, but also in 
function, while the term tumor means an increase in size with no 
corresponding increase in function. A forcible illustration of these 
two conditions may be drawn from a normal and an abnormal accumu- 
lation of fat. Even a normal accumulation of fat may be very much 
localized, as when, for instance, it is chiefly confined to the omentum, 
but however localized a normal accumulation of fat may be, it is readily 
utilized when demanded by the necessities of the body, but a lipoma 
or fatty tumor remains practically unaffected by the needs of the body, 
even if these needs press to the point of starvation. 

A hypertrophied gland is capable of more functional activity than 

*Bulletin So. Cal. Acad. Sci., June, 1906. 



206 SCIENTIFIC INVESTIGATIONS 

a strictly normal gland, as, for example, the highly hypertrophied 
mammary gland of the domestic cow compared with the strictly nor- 
mal gland of the buffalo cow, while a gland enlarged by an adenoma — 
a gland-like tumor — is never more active and usually much less active 
than a strictly normal gland. 

Pathologists recognize two distinct kinds of tumors — those which 
are formed from epithelial cells and those which are formed from 
connective tissue cells. Cancers belong to the first class. 

Tumors of both classes closely resemble normal tissue in their 
nutrition, and they usually have about the same nerve supply. As the 
tumor increases in size, the blood supply is more or less affected and 
thus the cells composing the tumor are placed in a different environ- 
ment, which quickly reacts upon their structure and function. Owing 
to this fact, the clear distinction between cells of different tissues, 
which exists in normal structures, becomes more or less obliterated, 
and in many cases these distinctions become so illy defined that the 
positive identification of a given tumor becomes a matter of extreme 
difficulty or in some cases an impossibility. 

- I am aware that the foregoing views are quite out of harmony 
with the views of many writers and lecturers on pathology, but I be- 
lieve that the laboratory experience of practical workers is in har- 
mony with the views expressed. 



*WHICH WEIGHS THE MOST THE EGG OR THE CHICKEN 
WHICH COMES FROM THE EGG? 

This question has been guessed at a number of times, but I do 
not remember ever having seen exact data given in regard to the 
matter. With a view of answering the question with scientific ex- 
actness, Dr. J. O. Hunt, of Los Angeles, carried a fertilized and an 
unfertilized egg through the whole process of incubation with the 
results given below by the eggs indicated by A and C. More than a 
year after Dr. Hunt's experiments, I carried eggs B and D through 
the same treatment. The tabulated results are here presented. 

*Bulletm So. Cal. Acad. Sci., Dec, 1906. 



WEIGHT CHANGES 207 



Days 


A. 


B. 


C. 


D. 


1 


.573 gr. 


.590 gr. 


.387 gr. 


.552 gr, 


2 


.586 


.603 


.420 


.586 


3 


.614 


.608 


.483 


.563 


4 


.543 


.601 


.400 


.574 


5 


.569 


.594 


.433 


.583 


6 


.542 


.602 


.407 


.356 


7 


.583 


.593 


.431 


.394 


8 


.543 


.595 


.425 


.399 


9 


.660 


.599 


.484 


.400 


10 


.682 


.594 


.508 


.409 


11 


.497 


.714 


.386 


.658 


12 


.693 


.693 


.536 


.649 


13 


.481 


.654 


.278 


.603 


14 


.567 


.633 


.526 


.559 


15 


.570 


.622 


.430 


.587 


16 


.582 


.601 


.434 


.503 


17 


.656 


.594 


.481 


.501 


18 


.574 


.602 


.409 


.409 


19 


.714 


.604 


.492 


.386 


20 


.824 


.603 


.418 


.351 


21 




.604 




.309 


22 




.796 




.250 



Egg A weighed at beginning of incubation 59.76 g., and during 
the process of incubation lost 12.053 g., or a little more than 20 per cent. 

Egg C, a sterile egg subjected to the same treatment, lost 8.768 g., 
or 15.5 per cent. 

Egg B weighed at the beginning of incubation 62.842 g., and 
during the time of incubation lost 13.699 g., or 21.64 per cent. The 
chick hatched from the egg weighed 44.204 g., or 18.638 g. less than the 
egg before incubation, a loss of 29.65 per cent. 

Egg D was so violently shaken previous to incubation that it was 
killed. Its treatment was the same otherwise as Egg B. The loss of 
egg D during incubation was 10,571 g., or a loss of 17 per cent. 



208 SCIENTIFIC INVESTIGATIONS 



^DEGENERATES. 

One does not read modern magazines very extensively without 
seeing some reference made to degeneracy. Although our knowledge 
of the subject is of recent origin, considerable literature relating to it 
is already accessible. A large part of this is scattered through maga- 
zines and other periodicals, but a few books of real value are wholly 
devoted to discussion of this most practical and interesting question. 
Among these may be mentioned "Degeneration," by Prof. Max Nor- 
dau, "Degeneracy, Its Causes, Signs and Results," by Dr. Eugene S. 
Talbott, and a work on "Degeneration," by Dr. Hirsch. 

In the present article I have no intention of materially increasing 
the stock of information on this subject, but rather of putting in a con- 
densed form the work which has already been done by others. 

Degeneracy may be defined as a failure on the part of the indi- 
vidual to reach the state of perfection attained by his (or its) ances- 
tors, and the inability to transmit to the next generation the peculiari- 
ties which mark the degenerate, though the descendants are seldom 
or never free from some serious defects. It is this latter fact which dis- 
tinguishes a "degenerate" from the beginning of a new species or race. 
Fortunately for the dignity of life, degenerate plants and animals at 
last lose their powers of reproduction and so become self-limiting. 
Marked degeneration is possible only when the degenerate can act as 
a parasite. 

Conversely, parasitism always leads to degeneration, the amount 
of which is closely proportioned to the extent of the parasitical habits. 
Without parasitism, the tapeworm could never have lost its alimentary 
canal and other digestive organs. Even a slight tendency toward 
their degeneration before parasitical habits were well established would 
have been fatal to the whole race, and human parasites, criminals and 
incompetent people, can live only through the charity of their more 
highly developed brethren. Volumes might be written on the causes, 
nature and biological significance of animal degeneration, but in this 
article I shall confine myself to the human aspect of the case, only 
where some illustration drawn from zoology or botany will make my 
meaning more clear. All scientists admit that each animal in its indi- 
vidual development recapitulates more or less perfectly the history 
of the race to which it belongs. Thus the frog when first hatched is 

*The Osteopath, P. S. O., May, 1900. 



DEGENERATES 209 

essentially a fish, but by a series of changes it develops into what is prac- 
tically a reptile. Its development before hatching is no less remarkable, 
for it begins life as a unicellular organism and grows into a fish, before 
it attempts any independent life. Some parts of its Qgg development 
closely parallel the development of worms, and we have every reason 
to believe that in a general way the race has traveled the road over 
which the individual now goes. Like the frog, man begins his life as 
a single cell and passes through about the same stages as the frog, 
and then continues his upward course until he reaches the full stage 
of human development. 

The limbs of man develop from the same embryological structure 
as do the fins of fishes. In degenerates one or even all of the limbs 
may remain in the finfold state and never develop, or while the arms 
or legs are arrested in their growth the other limbs (legs or arms) 
may grow in a perfectly natural way. Some of the bones of one or 
both pairs of limbs may remain undeveloped while other bones in the 
same limbs may attain normal size. 

Thus in one recorded case, the humerus and radius and ulna were 
suppressed, but the lower bones were perfectly normal, so this un- 
fortunate had two well formed hands projecting from the shoulders. 
In a number of cases the lower limbs have been completely fused 
together. The number of ribs is subject to variation. It is seldom 
that the number is less than normal, and in the great majority of cases 
where degeneracy is marked by an increased number, thirteen pairs 
are found. This is the number found in the anthropoid apes, most 
nearly related to man. The patella bone is frequently absent in de- 
generates. 

There is strong evidence that in ancestral forms a close relationship 
existed between what is now the central nervous system and the alimen- 
tary canal. In embryonic life the lumen of the spinal cord and alimentary 
canal are connected by what is known as the neurenteric passage or 
canal. This place is occasionally the seat of degenerate conditions, 
which may so expose the spinal cord as to render life precarious. In 
England alone six hundred and forty-seven deaths were reported from 
this cause in 1882 and of this number six hundred and fifteen were 
children under one year of age. 

The heart is sometimes very imperfectly developed. It has been 
found in almost all stages, from a mere pulsating tube up to a perfect 
mammalian heart. Strange to say, a very poorly developed heart has 
sometimes performed its functions well. When the embryonic con- 



210 SCIENTIFIC INVESTIGATIONS 

dition of an open foramen ovale persists after birth the child is popu- 
larly called a "blue baby." 

Various forms of physical degeneration which do not seriously 
affect the intellect are so common that I shall pass them over briefly. 
They may be divided into two classes which are not always easily dis- 
tinguished from each other. One class comprises those cases where 
the deformity bears no relationship to ancestral conditions. Such are 
the microcephalous, macrocephalous and hydrocephalous monsters, 
and cases of supernumerary ears, limbs and digits as well as those 
with two or more heads. The other class of degenerates are those of 
atavism or a reversion to an ancestral form. This does not imply the 
possession of simply rudimentary organs, for the bodies of higher ani- 
mals are pretty well filled with these, but it means that some organ 
which is usually suppressed becomes developed to such an extent as to 
be of functional value. The mental and moral degenerates are crimi- 
nals and imbeciles. There seem to be at least two classes of criminals : 
accidental criminals and natural criminals. The accidental criminal 
Js one who has been led into crime by some strong and temporarily 
overmastering temptation. Nothing is more sad than criminality of 
this kind, and these accidental criminals not infrequently "rise from 
their dead selves to higher things." 

The natural criminal is believed by Lombroso and other crimin- 
ologists to represent a distinct variety of human race. As children 
they are frequently deformed, puny, sickly, inclined to scrofula, with 
peculiar shaped heads, insignificant in hearing and markedly deficient 
in energy. Mentally they are inclined to be stupid, subject to fits, 
sluggish in movement, and at the same time petulant, and often in- 
corrigible. As adults their heads are irregular in outline, sharp and 
angular, and they have a stupid and insensate look. Serious physical 
deformities, such as club-feet, cleft-palate, hare-lip, hump-back and 
general asymmetry of the body, are not uncommon among them. 
Especially are the eyes Ukely to lack symmetry. 

In homicides it has been noted that the angle of the ear with the 
temporal bone is generally large, approaching 90°. In habitual thieves 
the angle of the ear is generally somewhat less, but still greater than 
is that of perfectly normal individuals. 

Albinism or deficient pigment in the skin is often associated with 
serious moral and intellectual weakness and is frequently combined 
with imperfectly developed spleen, liver, pancreas and kidneys. 

The imperfect and irregular action of the lungs arising from the 



DEGENERATES 211 

imperfectly developed face, jaws, palate, nose or chest, may result in 
an irregular blood supply to the brain. This may result in lowering 
the intellectual and hence the moral tone of the individual. 

In 1886 Dr. Henry D. Chapin expressed the opinion that the in- 
efficient and criminal classes are an inevitable by-product of our com- 
plex modern civilization. Evils are always "inevitable" until we know 
how to deal with them, but when we have learned how to deal with 
them it is surprising to note how soon they cease to be "inevitable." 
One need not go very far back in the history of Anglo-Saxon philan- 
thropy to find the time when it was supposed to be desirable to lift the 
imbecile to a plane where he could support himself, and assume a more 
or less independent condition among his fellow men, and it was sup- 
posed to be equally desirable to so improve the natural criminal that 
he could spend at least enough time outside of jails and penitentiaries 
to enable him to marry and raise a family. The state still stands ready 
to license the marriage of physical and mental degenerates — the imbe- 
cile and the criminal — and the church gives them her blessing and 
bids them "be fruitful and multiply." One important step in the real 
redemption of man will have been taken when this maudlin sentimen- 
tality shall have come to an end. 

Every human being, the most degenerate as well as the most 
highly endowed, is entitled to life and its comforts, and as much liberty 
as is consistent with the safety of others, but when one is a well- 
marked degenerate of any kind he should never be permitted to per- 
petuate his race. Instead of sending the young criminal — the natural 
criminal — to the reform school until he is of age, and then turning him 
loose and granting him permission to marry and raise a family, which 
experience shows will generally inherit his bad tendencies, he should be 
placed in some institution for life where he can be of use to himself 
and to others, but where he can leave no descendants to follow in 
his steps. 

Frequently a considerable part of the mature life of such a man 
is spent in criminal pursuits, and he is on the whole a nuisance to his 
own generation, and his children become the "problems" of future 
generations. As a matter of simple justice to the future, no degenerate 
should be allowed to have descendants. His life should be made as 
happy and comfortable as possible, but he should be the last of his race. 
One serious obstacle stands in the way of reform in this direction, and 
that is the difficulty of accurately recognizing degenerates. Careful 
and thorough study of all the phases of degeneration must precede 



212 SCIENTIFIC INVESTIGATIONS 

any wise movement toward regulating the lives of degenerates. 
The field is a new one and practically unoccupied now, but the 
work will be taken up in good earnest in the near future. Why should 
not Osteopaths specialize in this direction? The old school of the 
healing art has raised the treatment of insanity from "casting out 
devils" to a truly scientific method. Shall they be left to deal with the 
problems of degeneration alone, or shall Osteopaths fit themselves for 
at least intelligent cooperation? 

In conclusion I only wish to remind Osteopaths that the standing 
of Osteopathy will be largely measured by the value of its contribu- 
tions to the world's betterment. To develop as it should it must not 
only be a method of curing disease, but it must assist in the solution 
of the biologic social problems which confront us. 



*ALBUMIN AND CASTS. 

Slight albuminuria may indicate Bright's disease or nephritis in 
a very incipient condition. It may also indicate either acute or chronic 
inflammation of the urinary tract. It is by no means unusual in heart 
lesions, in hepatic sclerosis, and where abdominal tumors are of suf- 
ficient size to interfere with the circulation of the blood. In fact, 
albuminuria may indicate almost any urinary or systemic perversion. 

It is perhaps safe to say that nephritis never exists for any con- 
siderable time without more or less albuminuria. In many cases, how- 
ever, of unquestioned nephritis, it is not a constant condition. Asso- 
ciated with albuminuria is the passage of hyaline casts. As a result of 
a good deal of work and reasonably close observation I have become 
convinced that many of our text books place an exaggerated diagnostic 
value upon hyaline casts. I have become convinced that disturbances 
of the system which are very trifling, and which are not far-reaching 
in their results, may lead to the elimination of these casts. It is the 
exception rather than the rule not to find hyaline casts in the urine of 
people over forty years of age who come under clinical examination. 
In a number of cases which I have had an opportunity of studying 
with some degree of care, these casts are so constantly present that 
they almost lead one to think of them as physiological rather than a 
pathological condition. It of course must not be forgotten that a mod- 
erate albuminuria accompanied by hyaline casts may be the forerunner 
of an extremely serious condition. On the other hand, as before 
hinted, they may exist for years without serious conditions manifesting 
themselves. 



*West. Ost., March, 1911. 



SPERMATOZOA 213 



^SPERMATOZOA. 



The spermatozoa, or male reproductive cells are the smallest cells 
found in the mammalian body, and they constitute the only good ex- 
ample which we have of flagellate cells in the bodies of the higher 
animals. A number of unicellular organisms are examples of flagellate 
cells leading an independent existence. Of the numerous ones which 
might be cited I shall mention only the Euglena. Each spermatozoan 
consists of a head, mostly composed of nuclear substance with a more 
or less conspicuous head cap at the anterior end. When this head cap 
is clearly defined it is sometimes spoken of as the acromosome. The 
head is surrounded by a thin layer of cytoplasm which also more or 
less completely invests the tail. Immediately posterior to the head is 
the middle piece containing a body which is probably the centrosome, 
and posterior to the middle piece is the axial filament. It occasionally 
happens that the filament which is surrounded, as already stated, to a 
greater or less degree, by the cytoplasm, projects through this envelepe 
at its posterior end. When this condition is found the projecting por- 
tion is frequently spoken of as the End Piece and the staining reaction 
of this structure indicates its relation to the nucleus. 

During the last year I have made somewhat of a critical study of 
the spermatozoa of seven different animals. The species studied in- 
cluded man, the dog, the rabbit, the bull, the mouse, the cat and the 
rat. In all of these I find that the head breaks off very readily if the 
spermatozoa are immersed for any length of time in cold water. The 
tendency for this division to occur is less marked in warm water, and 
very decidedly less in a normal salt solution. The media in which the 
spermatozoa are placed also exercise a marked influence upon their 
vitality. They are, of course, quickly killed when placed in any of 
the fixing media commonly used in histological laboratories. Their 
vitality is maintained for only a short time in pure water. They die 
very quickly in cold water and live not very much longer in water at 
the temperature of the animal body. Under favorable conditions the 
spermatozoa of the cat and man will live for forty-eight hours and 
possibly even longer in a normal salt solution. In no case which I have 
had an opportunity of studying with care do they retain their vitality 
for any length of time in the testicle. Even when the testicle is removed 
from the living animal and immediately placed in a warm normal salt 

*West. Ost., Feb., 1908. 



214 SCIENTIFIC INVESTIGATIONS 

solution the spermatozoa die within a few hours. Fine specimens may 
be stained by the carbolfuchsin method, or by Gram's method. Methy- 
lene blue followed by eosin also gives fairly good results and I have been 
greatly pleased with some specimens stained with iron haematoxylin. 
I have been unable to find a method by means of which the tails will 
retain their stain for any great length of time, unless the heads are much 
over stained. 

MAN AND DOG. 

While the spermatozoa of the man and dog possess some individual 
peculiarities in the fresh state they are so much alike when stained that 
it is extremely difficult to recognize the difference between them. On 
the whole, the head of the human spermatozoan stains rather more 
deeply than does that of the dog, and it is rather more pointed at the 
anterior head. The head of the spermatozoan of the dog is more oval in 
shape and the anterior end stains very lightly. The tail is, upon the 
whole, somewhat longer than the human as the subjoined measurements 
will show. The dog from which these specimens were taken weighed 
about forty pounds and was an old dog. 

MAN. DOG. 

Total length .049— .06 m. m. Total length .06— .07 m. m. 

Length of head .004— .0065 m. m. Length of head .003— .0035 m. m. 

Width of head .003— .004 m. m. Width of head .0015— .002 m. m. 

Length of tail .04 — .05 m. m. Length of tail .055 — .06 m. m. 

CAT. 

The spermatozoa of the cat differ somewhat from those of any of 
the other animals in this series, inasmuch as when the specimen is fixed 
in ether and alcohol the tail shows distinct fibrillse which sometimes 
divide in the middle piece and appear to pass forward and nearly or 
quite envelope the head in a net-work of fine achromatic threads. In 
several specimens which I studied carefully the heads are found to vary 
in a marked degree in size and shape. 

Total length .056— .076 m. m. 

Length of head .0035— .0075 m. m. 

Width of head .0025— .003 m.m. 

Length of tail .05 — .07 m. m. 

mouse:. 

The head of the spermatozoan of the mouse stains deeply. The 
chromatic part of the head is surrounded by a nearly transparent en- 



SPERMATOZOA 215 

velope. The anterior end of the head is provided with a curiously 
curved projection which might be compared to a horn. 

Total length .1 .165 m. m. 

Length of head .0083 .01 m. m. 

Width of head .0025 .0035 m. m. 

Length of tail .115 .14 m. m. 

BULL. 

There is a marked tendency for the head to break off from the tail 
in the spermatozoan of the bull. This is so marked that difficulty is 
sometimes experienced in finding complete spermatozoa. The centro- 
some stains much more deeply than the head, and the tail takes the 
stain more readily than it does in most other forms which I have ex- 
amined. 

Total length .085 .095 

Length of head .008 .01 

Width of head .0055 .0065 

Length of tail .075 .086 

RABBIT. 

The spermatozoa of the rabbit closely resemble that of the dog, 
the most striking difference between the two being the tendency of the 
tails of the spermatozoa of the rabbit to form complicated curves and 
frequently to become entangled with each other. 

Total length .05 .07 m. m. 

Length of head .0055 .0065 m. m. 

Width of head .003 .0045 m. m. 

Length of tail .04 .06 m. m. 

WHITE RAT. 

The spermatozoa of the rat differ widely in appearance from that 
of any other of the mammals in this series. In some respects they re- 
semble the spermatozoa of the barn-yard cock. The heads are cres- 
centric in shape and the concave border stains more readily than any 
other part of the head. 



Total length 


.22 


.24 m. m 


Length of head 


.013 


.017 m. m 


Width of head 


.005 


.007 m. m 


Length of tail 


.21 


.23 m. m 



216 SCIENTIFIC INVESTIGATIONS 



*OUR NATIVE BIRDS. 

Dr. Elliott Coues, in his "Key to North American Birds," which 
by the way is a rare combination of poetry and science, says : "There 
is every reason to believe that a bird is a greatly modified reptile, being 
the offspring by direct descent of some reptilian progenitor ; and there 
is no reason to suppose that any bird ever had any other origin than 
by due process of hatching out of an egg laid by its mother after 
fecundation by its father." 

Notwithstanding the lowly origin thus assigned to birds, their 
grace, their beauty, their songs and their practical usefulness combine 
to render them worthy of the most careful study and attention. Until 
recently naturalists deemed it beneath their dignity to study a bird 
until it was dead, and to insure proper dignity even then, it was neces- 
sary that the bird should have been killed. Audubon and Wilson were 
two marked exceptions to the foregoing statement, but even their in- 
fluence was insufficient to awaken an interest in living birds. Recently, 
however, the tide seems to have turned, and now all over our land birds 
are being studied in their native haunts, and the student of ornithology 
is quite as likely to be armed with a field glass as with a gun. 

Much good work is being done in this line by the teachers and 
pupils in our public schools, and it is in the hope of aiding this work 
that I present a classified list of the birds living in Utah. 

It is highly improbable that I have the names of all of our native 
birds, but I am quite sure that no bird has been admitted to this list 
which is not a native. 

As all readers may not be familiar with the nomenclature which I 
use, a brief explanation of it will perhaps prove useful. 

All animals belong to the kingdom animalia. All of the animalia 
which have backbones belong to the sub-kingdom vertebrata. Those 
vertebrata which are feathered bipeds are members of the class aves, or 
birds. The aves are divided into thirteen divisions, known as orders, 
which are founded on well-marked characteristics. The divisions of 
the orders are called families, and each family is composed of one or 
more groups known as genera (a single one is a genus). Each genus 
consists of one or more birds, known as species. The species composing 
a genus closely resemble each other, but each one has some special 

*Pub. in Salt Lake City, Utah, May, 1898. 



OUR NATIVE BIRDS 217 

peculiarity. In some cases the difference between two birds is not 
enough to entitle them to rank as two species, and one of them is 
called a sub-species. 

The scientific name of an animal consists of the generic name, fol- 
lowed by the name of the species. Thus the domestic cat belongs to 
the genus Felis and to the species domestica. Its scientific name is 
Felis domestica. If the animal named ranks as a sub-species, the name 
of the sub-species follows the specific name. Thus our most common 
robin is the Turdus migratorius, while a bird slightly larger, living in 
the mountains, is a Turdus migratorius propinquus. 

The largest and most important order of our native birds is the 

ORDER PASSKRES. 

The word "passer" means a sparrow, and this bird is a type of the 
order. All of our perching and song birds are Passerine birds. 

The toes are four in number and the birds usually move by hopping 
when on the ground rather than by walking, but they are essentially 
flying birds, and seldom attempt a journey of any magnitude except 
on the wing. 

Our native species are as follows: 

(Initial letters are used to abbreviate wherever possible.) 

Turdus migratorius Robin; T. M. propinquus, Allied Robin (a 
species found in the mountains) ; Turdus unalascae auduboni, Audu- 
bon's Hermit Thrush; Oroscoptes montanus, Mountain Mocking 
Bird; Mimus carolinensis, Cat Bird; Harporhynchus crissalis, 
Crissal Thrasher; Cinclus mexicanus, American Dipper (a curi- 
ous bird found along our canyon streams) ; Sialia mexicana, 
Western Blue-Bird; S. arctica, Rocky Mountain Blue-Bird; Lo- 
phophanes inornatus, Plain Titmouse; Parus montanus, Mountain 
Chickadee; Campylorhynchus brunneicapillus, Cactus Wren; Cath- 
erpes mexicanus conspersus, Canon Wren; Troglodytes domesticus 
parkmani, House Wren ; Eremophila alpestris leucolaema, Shore Lark ; 
Dendrceca sestiva, Golden Warbler ; D. occidentalis, Western Warbler ; 
Hirundo erythrogastra horreorum, Barn Swallow; Petrochelidon luni- 
frons, Mud Swallow ; Cotile riparia, Bank Swallow ; Ampelis garrulus, 
Bohemian Waxwing; A. cedrorum, Cherry-Bird (both of the above 
named birds are remarkable for their general beauty and their fine 
topknots); Lanius borealis, Butcher-Bird ; Hesperophona vespertina, 
Evening Grosbeak ; Passer domesticus, Common Sparrow ; Carpodacus 
cassini, Purple Finch; C. frontalis, Crimson-Fronted Finch; Leucos- 



218 SCIENTIFIC INVESTIGATIONS 

ticte atrata, Rosy Finch; L. tephrocotis litoralis, Baird's Rosy Finch; 
Astragalinus tristis, Yellow Bird; Plectrophanes nivalis, Snow Bunt- 
ing; Melospiza palustris, Song Sparrow; Amphispiza bilineata, Sage 
Sparrow; Junco hiemalis, Snow-Bird; J. h. oregonus, Oregon Snow- 
Bird; Guiraca coerulea, Blus Grosbeak; Pipilo aberti, Gray Towhee; 
Dolichonyx oryzivorus, Bobolink ; Molothrus ater, Cow-Bird ; Agelaeus 
tricolor, Red and White Marsh Black-Bird; Xanthocephalus icterocep- 
halus, Yellow Headed Black Bird; Sturnella magna, Meadow Lark; S. 
neglecta, Western Meadow Lark; Icterus bullocki, Bullocks Oriole; 
Corvus corax, American Raven; C. frugivorus, Common Crow; Pica 
rustica hudsonica, Magpie ; Cyanocitta stelleri macrolopha, Crested Jay ; 
Alphelocoma floridana woodhousii, Woodhouse's Jay; Tyrannus caro- 
linensis, King-Bird; Myiarchus cinerescens, Crested Flycatcher. 

ORDER PICARIAE. 

The Picarian birds constitute an illy defined group of land birds 
with straight bills and four toes. In one large division of this order 
(the wood-peckers) the toes are in pairs, two in front and two behind. 
Antrostomus vociferus arizonae, Arizona Whipperwill. (So far as I 
can learn this bird occurs only in the extreme southern part of the 
state.) Chordediles popetue henryi, Night Hawk; Trochilus alexandri, 
Humming Bird; Selasphorus rufus, Red-Backed Humming-Bird ; S. 
platycercus, Broad-Tailed Humming-Bird; Ceryle alcyon, Kingfisher; 
Coccygus erythrophthalmus, Black-Billed Cuckoo; Picus scalaris, 
Woodpecker; P. villosus harrisi, Harris Woodpecker; P. pubescens 
gairdneri, Gairdener's Woodpecker; Melanerpes erythrocephalus, Red- 
Headed Woodpecker; Colaptes mexicanus, Red-Shafted Woodpecker. 

ORDER RAPTORES. 

These are the birds of prey. Their toes are four in number, and 
are fitted for grasping. The beak is strong and hooked at the end. 
Most of them are birds of powerful flight. Those which seek their 
prey at night are the Owls, while the others are the Hawks, Eagles, 
Buzzards, etc. 

Bubo virginianus arcticus, White Horned Owl. (This owl occas- 
ionally strays as far south from his northern home as Salt Lake City. 
So far as I know he is found here only in the winter.) Scops asio 
bendirii, Screech Owl ; Asio wilsonianus, Long-Eared Owl ; A. acci- 
pitrinus, Short-Eared Owl; Nyctea scandiaca, Snowy Owl; Speotyto 
cunicularia hypogsea, Burrowing Owl ; Accipiter fuscus, Sharp-Shinned 
Hawk; Astur atricapillus, Chicken Hawk; Buteo borealis, Red-Tailed 



OUR NATIVE BIRDS 219 

Buzzard; Aquila chryssetus, Golden Eagle; Halisetus leucocephalus, 
Bald Eagle. 

ORDER COLUMBAE. 

The Pigeon is a type of this order. The bill is horny in structure, 
and the nostrils open into a tumid membrane at its base. The toes are 
four in number, and occasionally a slight web is found connecting 
them. Columba fasciata, Band-Tailed Pigeon; Zenaidura carolin- 
ensis, Wild Dove. 

ORDER GALLINAE. 

This order includes the scratching birds and the domestic fowl, 
the turkey, the pea-fowl and the Guinea fowl are familiar examples. 
Meleagris gallipavo americana, Wild Turkey; Canace obscura, Gray 
Grouse; Centrocercus urophasianus, Sage Hen; Pedioecetes phasi- 
anellus columbianus, Sharp-Tailed Grouse; Bonasa umbella umbel- 
loides, Ruffed Grouse ; Lophortyx gambeli, Arizona Quail ; L. Califor- 
nia, Valley Quail. (This beautiful bird appears to be an introduced 
species, but in some parts of the state it is becoming abundant.) 

ORDER LIMICOLAE. 

The birds are frequently called shore-birds, from the fact that 
they are usually found along the shores of lakes and ponds and occas- 
ionally along river flats. Their food consists of worms, insects and 
other forms of small soft animals, which they pick from the water. 
Aegialites vociferus, Kildeer Plover; Ae. semipalmatus, Ring Plover; 
Podasocys montanus, Mountain Plover; Recurvirostra americana, 
American Avocet; Phalaropus fulicarius, Red Phalarope; Actodromas 
bairdi, American Stint; Symphemia semipalmata, Willet; Numenius 
longirostris, Sickle-Billed Curlew. 

ORDER HERODIONES. 

The birds of this order are mostly large and the legs are long. 
They usually live in lonely bogs and swamps. Their food consists of 
fish, frogs and small reptiles. The bill is stout and long. Plegadis 
guarauna, Ibis ; Ardea herodias, Blue Heron ; Herodias egretta, White 
Heron; Nyctiardea grisea nsevia, Night Heron; Botaurus mugitans, 
American Bittern. 

ORDER ALECTORIDES. 

The external characteristics of this order are so much like the 
last that the casual observer would see little on which to found a sep- 
arate order. Grus pratensis, Sand Hill Crane ; Porzana Carolina, Com- 
mon Rail; Fulica americana, Mud Hen. 



220 SCIENTIFIC INVESTIGATIONS 

ORDER LAMELLIROSTRES. 

Domestic Geese and Ducks are examples of birds belonging to 
this order. Cygnus buccinator, Trumpeter Swan; C. columbianus, 
American Swan; Anser albifrons gambeli, White-Fronted Goose; A. 
hyperboreus, White Brant; Bernicla canadensis, Wild Goose; Dendro- 
cygna fulva, Tree Duck ; Anas boscas, Mallard Duck ; Dafila acuta, Pit- 
Tail Duck; Chaulelasmus streperus, Gray Duck; Mareca americana, 
Bald-Pate Duck; Querquedula carolinensis, Green-Winged Teal; Q. 
cyanoptera, Cinnamon Teal; Clangula islandica, Rocky Mountain 
Garrot; C. albeola, Butter-Head Duck; Somateria mollissima dresseri, 
Eider Duck; Mergus serrator, Red-Breasted Duck. 

ORDER STEGANOPODES. 

These birds are provided with a pouch under the chin in which 
the prey is sometimes kept before it is swallowed. Our most common 
species is the Pelican. This bird is very destructive to fish, but it 
partially atones for this serious fault by devouring large numbers of 
frogs, which feed upon about the same material as fish. Pelecanus 
trachyrhynchus, American White Pelican; Phalacrocorax dilophus, 
Cormorant. 

ORDER LONGIPENNES. 

As the name of the order indicates, these birds have long wings 
and are well fitted for prolonged flight. So far as is at present known, 
only two species are found in Utah. Larus argentatus smithsonianus, 
Herring Gull; L. calif ornicus, Calif ornian Gull. (This is the gull so 
common around Great Salt lake.) 

ORDER PYGOPODES. 

The birds belonging to this order have their legs so far back on 
the body that they are forced to stand in a nearly erect position. They 
are strong swimmers and have good powers of flight. While they are 
mostly marine birds at least three species are found around Utah lake 
and Great Salt lake. Colymbus torquatus, Common Loon; Aechmo- 
phorus occidentalis, Western Grebe; Podicipes auritus californicus, 
Eared Grebe. 

It is highly improbable, as I have before stated, that the foregoing 
list includes all of our birds, but I feel quite sure that every bird which 
has been named is found within the state and most of them breed with- 
in our borders. Public interest demands the extermination of the 
sparrow, if that were possible, and the reduction in numbers of the 
pelican. All of our other birds should be protected as the harm they 
do is small, when compared with the benefits they confer. 



PART III. 
Osteopathic Education 

*ADDRESS TO P. S. O. GRADUATING CLASS, 1900. 

Let me advise you to be in no haste to define Osteopathy. The 
history of the healing art shows that it has been eminently progressive, 
and we certainly have little reason for supposing that Osteopathy, as 
we understand it today, is a finality. When definitions and creeds 
are formulated they always express the broadest truth known to their 
makers, but as knowledge broadens they become a hindrance to prog- 
ress. The creed of one generation is the prison in which the intellect 
of the next is too often confined. 

Let Osteopathy be free to grow. Let every Osteopath be an in- 
vestigator and let him discover as much new truth as he can, and let 
Osteopathy be broad enough to receive this new truth. Whatever is 
true in the art of alleviating human suffering will prevail, and the 
Osteopaths of today will be very unwise to prevent Osteopaths of the 
future from using such means of curing human ills as shall be proved 
effective. Whenever an organization, be it church, political party, 
medical school or any other, shall found itself upon a deeper devotion 
to truth than to preconceived ideas or creeds, that organization will be 
world-conquering. The attitude of the man who is intellectually free is 
expressed in the thought, "Let me know the truth; I care not for my 
previous views only so far as they were true; I will welcome investi- 
gation in every line, and I will cheerfully abandon any intellectual 
position so soon as I see that it is not in harmony with truth." Only 
men in harmony with this thought can advance the world. Never seek 
the fatal help of class legislation. Encourage investigation in every 
direction. Accept new truth from without as well as from within. 
Count that man as your friend who shows wherein you are wrong. 
Herbert Spencer once said, "To save men from the consequences of 
their own folly is to fill the world with fools." To save any organiza- 
tion from the consequences of its conservatism is to prevent its further 
growth. 

Welcome competition, challenge investigation, keep up with scien- 
tific progress, love truth better than you love your ideas of truth, and 
your reward will be the consciousness that you are helping in the 
grand evolution of the progress of mankind. 

*Pub. The Osteopath, P. S. 0., July, 1900. 



222 OSTEOPATHIC EDUCATION 



*THE PLACE OF PHYSICIANS IN MODERN SOCIETY. 

Modern society is readjusting itself along all lines. Such read- 
justment must eventually be made because of the increase of knowl- 
edge among men. 

Socially, we are studying anew the great problems concerning the 
distribution of wealth. We are concluding that it is very much more 
important to prevent poverty than it is to give in charity. 

Politically, we are growing out of the thought that "to the victor 
belongs the spoils," and growing into the higher and nobler thought 
that "a public office is a public trust." 

Religiously, we are concluding that it is much more important to 
make better the present conditions of life than to undertake to make 
provisions for a future of which at best we can know little. 

Around medical lines we are paying much more attention to the 
prevention of disease than did those who went before us. It is by no 
means easy to deal justly with the physician and medical art of the 
past. The old family physician, the kind sympathetic friend, the brave 
night rider, are still pictures from which we can not willingly divorce 
ourselves. But there was another side to all of this. The sympathetic 
physician and loyal friend certainly poured drugs, "of which he knew 
little, into bodies of which he knew much less," and he certainly had a 
tendency to obscure the nature of the disease and the treatment which 
he gave for its alleviation. Perhaps it may be said in his justification 
that he never made these things more obscure in the minds of his 
patients than they were in his own mind. For, to tell the truth, he had 
not even a hint of the real nature either of the disease or its rational 
treatment. Disease to him was some kind of a terrible entity which 
got into the body and which, in some way, must be expelled and for 
the means for its expulsion he ransacked earth and sea for nauseous 
poisons. 

The modern conception of disease is altogether different. We have 
learned that contagious and infectious diseases result from organisms 
which enter the body, but we think of these as causes rather than the 
disease itself, and since we recognize the fact that disease has a cause 
we believe that it is, for that very reason, preventable. One can not 
do another a greater service than to impress upon him the solemn im- 
portance of a life-work and to teach him that it is only by the preser- 

*Address to P. C. O. Graduating Class, 1909. Pub. in West. Ost., Aug., 1909. 



PHYSICIANS AND MODERN SOCIETY 223 

vation of health that this life-work can best be accomplished. It is 
vastly more important to prevent disease than to alleviate it when it 
has become established. 

Death, so far as we are able to see, is a vital necessity. The living 
cell runs through a series of changes and at last its vitality is ex- 
hausted and its death is inevitable; but this should take place only in 
the extreme age of the cell; and what is true of the single cell is 
equally true of the great aggregation of cells which we call individual 
plants, animals and persons. If this view is true it means that death 
is as unnatural to the young as it is natural to the old. Few things 
should strike us as being more lamentable than the death of children. 
All sorts of consolations, which are inclined to make us reconciled to 
this terrible thing, are simply words which blind us to the wrong 
which we do when we permit the conditions to exist which cause this 
blot on the fair face of nature. Poet and preacher are alike at fault 
when they try to cast the soft light of poetry or religious consolation 
around an event of this character. Longfellow sings, "My Lord has 
need of these flowerets fair." The public hygienist, with perhaps less 
poetry, but much more truth, tells us "the Lord has need of the 
flowerets fair" in proportion as the milk furnished these 'flowerets' is 
unclean and contaminated by the germs of disease. Does this line of 
thought leave us without hope or consolation when our dear ones die? 
I think not. I think it offers us a rational source of comfort in the 
place of artificial and irrational comfort. The comfort offered by 
science is that the grief-stricken parent or friend should cultivate his 
philanthropy and unselfishness to such an extent that he shall say, 
"Out of my great grief good shall come, because I solemnly dedicate 
my life to helping to find means which shall prevent others from suffer- 
ing as I have suffered," and our world is built upon such a plan that 
the truest alleviation for all our griefs is to try to alleviate the sorrows 
of those who are around us. 

As each successive class goes out of our college it is highly im- 
portant that they be thoroughly trained in all that makes for good 
public hygiene. Each year must see better hygienic conditions and in 
the great work of improvement the physician must be the leader. If 
the Pacific College has succeeded in training this class in such a way 
as to make them intelligent leaders in this great movement, it has 
wrought a good work and justifies its existence in this community. 



224 OSTEOPATHIC EDUCATION 



*THE COURSE OF STUDY IN OSTEOPATHIC SCHOOLS. 

It is said, and probably with truth, that pedagogy is at a low ebb 
in professional schools, and it will be greatly to the credit of osteopaths 
if, in their schools, attention shall be given, not only to the subjects 
studied, but also to the manner and sequence of their presentation. 

Two things are required to complete the education of the modern 
physician. He must first be able to ascertain the abnormalities of 
his patient; second, he must be able to efficiently remove these abnor- 
malities and thus make possible the restoration of his patient's health. 
So far as his work in the school is concerned, it is frequently found con- 
venient to call subjects enabling him to accomplish the first result, 
foundation subjects; and those subjects which enable him to intelli- 
gently assist in the second result, professional subjects. However use- 
ful this division of subjects may be in explanation and discussion, no 
real line of demarcation exists between them, but they blend by im- 
perceptible degrees with each other. 

There is a natural conservatism running through the human mind, 
which makes us strongly inclined to cling to expressions which at 
some time expressed the truth as it was then understood. This we 
observe in every department of thought. Religious creeds are main- 
tained long after they cease to embody the real belief and real thought 
of the worshippers; social customs are respected long after their sig- 
nificance has been lost, and changeable as fashions of dress are, the 
deep underlying principles are changed very slowly. No man in civil 
life ever thinks of wearing a sword, nevertheless all of our Sunday 
coats are decorated with buttons originally designed to support the 
sword belt. 

In the early days of osteopathy, when its founders were being 
impressed themselves and were seeking to impress others with the 
importance of the physical lesion, nothing was more natural than that 
the science which makes the recognition of the physical lesion possible, 
should have been regarded as the very foundation of osteopathy, but 
at the present time when we are understanding more completely the 
importance of the cell and when we know that the normal functioning 
of the organism must depend upon the normal functioning of each 
of its component parts, we must recognize physiology, using the term 

*Ost. World, Oct., 1903. 



OSTEOPATHIC SCHOOLS 225 

in its broad sense, as the real foundation of all medical education. The 
term medical is also used in its broad sense, and by it I mean every 
rational method applied to the recognition and cure of disease. 

Physiology rests upon a three-fold base. One of its foundations 
is anatomy, the science of gross structure, another foundation is histol- 
ogy, the science of minute structure, and the third is chemistry, the 
science which makes the understanding of cell action possible. 

I would not for a moment underestimate the value of chemistry 
when applied to the analysis of the various bodily secretions, but its 
fundamental use in medical education is to enable one to thoroughly 
understand physiology. Pathology is abnormal histology and ab- 
normal physiology, and I believe it has no place in the curriculum of 
any medical school only as it is presented in close connection with 
these two subjects; and, as the latter one of these, physiology, rests 
in part upon anatomy and in part upon chemistry, these two subjects 
must of course be recognized as having an important bearing upon 
pathology. Bacteriology should be presented as throwing a strong 
side light upon many of the problems of both physiology and pathology. 

I would pause here to urge that in every case in our curriculums 
the study of the normal should precede the study of the abnormal. In 
sputum examination, urinalysis, blood examination, examination of 
gastric contents, fecal examination and in all others, a careful study 
of the normal is necessary to enable the student to get any real knowl- 
edge from the examination of abnormal specimens. 

Embryology should be made one of our heavy courses, as a just 
appreciation of anatomy, normal and abnormal, as well as many 
problems of physiology, rests entirely upon a knowledge of this 
science. I do not think that I put it too strongly when I say that 
embryology is the key and the only key to anatomy. When we can 
make our entrance requirements as high as we all wish were possible, I 
believe the study of embryology should precede the study of anatomy; 
but as it is frequently necessary to admit students who have not had 
the careful training which is necessary to enable them to study embry- 
ology with profit, it seems better to delay it until a later time in the 
course, even to the extent of making it follow anatomy. The extremely 
technical subjects of gynecology, surgery and obstetrics, all rest upon 
a profound knowledge of the human body, and as any good to be de- 
rived from these subjects must come very largely from clinical practice, 
it seems wise to relegate them to the latter part of the course. 

In this hasty sketch of the Osteopathic curriculum, I have omitted 



226 OSTEOPATHIC EDUCATION 

saying anything in regard to biology. I will here take space to say 
that I regard this as an exceedingly important subject in medical edu- 
cation, and I believe that its natural place is in the early part of the 
student's course. Through this science it is easy to introduce him to 
some of the fundamental problems of life, and in working upon these 
problems he acquires much laboratory technique which stands him in 
good stead during all the rest of his course. 

The only excuse which I have to offer for this discussion is that 
I am truly and deeply interested in seeing the courses in our osteo- 
pathic colleges made as strong from a pedagogical standpoint as I feel 
certain they are from the Osteopathic standpoint. 



Nothing appeals more forcibly to the educated person than 
breadth of thought. All except those who are running in a narrow 
groove naturally admire the order of mind which is broad enough to 
admit the possibility of truth outside the boundaries of his own men- 
tal horizon. 

As practitioners we are continually confronted by evidences of 
success from the use of methods outside the pale of the "ten-fingered 
osteopath," and we recognize that all of these methods which yield 
better results than can be obtained in any other way must eventually 
be incorporated into our system of practice, but we suspect that 
occasionally well-meaning people confuse their own ignorance with 
the supposed deficiency of the osteopathic system. We strongly sus- 
pect when an osteopath gravely informs us that the condition of his 
patient was such that he was obliged to use drugs to secure results, 
that if the real truth were told he would have been obliged to confess 
his own ignorance rather than the deficiency of the osteopathic system. 
The fact is certainly worthy of consideration that the most studious 
and untiring workers in our profession are those who resort to drugs 
the most infrequently, and we have a suspicion that those who rush to 
drugs most frequently are those who know the least about osteopathy. 



STUDY OF BACTERIOLOGY. 227 



*THE VALUE OF THE STUDY OF BACTERIOLOGY. 

Bacteriology, as its name indicates, is the science which treats of 
bacteria. By bacteria are meant those extremely minute forms of 
vegetable life which bring about many diseases and most of the com- 
mon changes which we observe in matter around us. The souring 
of milk, the putrefaction of meat, the decomposition of canned foods 
and the decay of wood, as well as many other like changes, all result 
from bacterial action. 

In the minds of many persons bacteria are regarded with a certain 
amount of abhorrence, not to say terror. This is because they are so 
generally associated with disease; but as a matter of fact, while there 
are a few forms which may find lodgment in the human body and 
whose action may produce disease, the greater number of bacterial 
forms are not only harmless, but are positively beneficial. Were it not 
for bacteria it is probable that the earth would be scarcely habitable, 
since all decay and decomposition is due to their action. The dead body 
of an animal kept entirely free from bacterial action would never under- 
go decomposition, and long before our time, the surface of the earth 
would have become so deeply covered with dead animals and plants 
that there would be no room for the living. 

As before stated, a few forms of bacteria are associated with dis- 
ease. Thus, tuberculosis, diphtheria, small pox, mumps, measles, var- 
ious kinds of fevers as well as a number of other diseases, result from 
bacterial action, but in the great majority of cases, at any rate, one 
may fully protect himself against the action of these harmful bacteria 
by keeping his body in a thoroughly healthy and vigorous state. 
While some specific bacteria are always associated with these diseases, 
it is nevertheless true that most of them are unable to find lodgment 
or to undergo development in the thoroughly healthy body. It is highly 
probable that one may spend his entire life in the midst of those 
suffering from tuberculosis, and may inhale the bacilli of tuberculosis 
daily without contracting the disease, providing he takes proper food, 
devotes enough time to sleep and otherwise keeps himself up to his 
best from a physical standpoint. Owing to the fact, however, that in 
our modern life it so frequently happens that we are more or less 
physically depressed, it becomes a matter of vital concern to know how 

*So. Pasadenan Aug., 1903. 



228 OSTEOPATHIC EDUCATION 

to diminish the number of the bacteria which produce the various 
diseases. An answer which will fit the greater number of cases con- 
sists in the single word cleanliness, and cleanliness in its broader mean- 
ing must of course include good ventilation, for it is quite as uncleanly 
to breathe impure air as it is to eat unclean food. 

Moisture is absolutely essential to the life of bacteria; hence dry 
and well drained places are always much freer from bacteria than 
places which are moist and where there is decaying organic matter. 
Indeed, as stated above, the decay is brought about by the action of 
bacteria. As long as bacteria are in a moist medium it is impossible 
for them to leave it and get into the air, but when the medium in which 
they are growing becomes dry, it is an easy matter for them to be 
picked up by currents of air from which they may settle into food or 
drink or be inhaled by breathing and thus find lodgment in the human 
body. 

One of the most filthy, dangerous and absolutely inexcusable habits 
is that of expectorating upon sidewalks, in cars and other public places. 
Wherever this filthy habit is permitted there is always more or less 
serious danger to the community at large, for among those who do 
this there is always the possibility of there being consumptives and 
those suffering from other diseases which might permit the presence 
of the specific bacteria of the diseases in the matter expectorated. 

It is an interesting thought that in the world of life, as in the 
social and moral world, it is the little things that count the most. It 
is of course needless to spend time in arguing that the proper attention 
to the small civilities of life mark the difference between the ill-bred 
person and the well-bred person, and in the organic world these micro- 
scopical forms of life produce more marked effects than the larger 
forms. Were all of the elephants and whales in the world to be 
stricken from existence, most of us would not be seriously affected; 
were these microscopical forms of life to disappear, the earth would 
soon be changed to an absolutely barren desert. This statement being 
true, it certainly should seem that the study of bacteriology is not un- 
important from the standpoint of general culture, and from the inti- 
mate relationship between certain bacilli and disease, it will readily 
enough be seen that a thorough understanding of these organisms 
should form an important part of the education of the physician. 



EDUCATION OF THE OSTEOPATH 229 



*THE EDUCATION OF THE OSTEOPATH. 

There is a serious danger that an increasing number of osteopaths 
look upon giving a "good treatment" as the sum and substance of os- 
teopathy; the "goodness" of the treatment being determined by the 
number and variety of the movements which the patient receives. No 
one who has the slightest interest in the advancement of the profession 
would intentionally undervalue its technique, but, after all, giving the 
"treatment" is only technique, and the ability to do it and do it well 
no more entitles one to be called a physician than does the ability to 
properly plant a tree entitle one to denominate himself a landscape 
gardner. 

No argument is needed to show that a correct diagnosis of disease 
must ever precede its rational treatment, and it is in making the diag- 
nosis that the skill and learning of the physician are shown. 

The osteopathic profession is rich in members who are strong in 
what they term "physical diagnosis." By this they mean palpation 
in its various forms, and the use of the stethoscope and the thermome- 
ter. All of these are good, and each of these means should be devel- 
oped to its utmost; but these are by no means all which the modern 
physician must use. Blood examination and urinalysis should form a 
part of the routine examination which every young physician gives 
his patient. I say "young physician" advisedly, for the physician of 
long experience may discern at a glance what the tyro would discover 
only after a long and patient research, just as the experienced mine 
prospector may safely stride over miles of the mountain side in a day, 
while the inexperienced prospector must assay a sample from every 
ledge if he ever expects to become an expert. 

In mentioning blood examination and urinalysis, I had no inten- 
tion of singling them out as of pre-eminent importance in all cases, 
though I believe they should form part of the routine examination to 
which every patient should be subjected. It is not a rare occurrence 
for a patient to pass from one reputable physician to another until he 
has gone through several hands before the real nature of his trouble 
is known. This would not be if every physician made it a point of 
honor to thoroughly investigate every case which he undertakes. The 
"shot-gun treatments," of which one so frequently hears, are a dis- 

*Ost. World, July, 1903. 



230 OSTEOPATHIC EDUCATION 

grace to the profession, and the osteopaths who give them have not 
the slightest claim to be called physicians. If such work is to be called 
"osteopathy," then instead of all the better schools putting themselves 
on a three-year basis, they should be adopting a three-weeks' basis, 
for any one who has ordinary mechanical ability can learn whatever 
there is of manipulation in that time. No one who is ignorant of the 
value in diagnosis, of blood, sputum, gastric and fecal examination, 
urinalysis, etc., has any moral right to engage in practice, no matter 
to what school he may belong. 

An argument which is used by some practitioners against care 
in diagnosis is that "no matter what the disease may be, the treat- 
ment is substantially the same." Now if this is true, let us have the 
courage of our convictions, and begin a systematic education of the 
public which shall result in having a brief course in osteopathic 
manipulation made a part of the curriculum of the public schools, and 
thus practically do away with the physician as a representative of a 
special profession. As this is a manifest absurdity, the right course 
to pursue is to put the profession on a high, scientific basis. To do 
this we must recognize the fact that questions relating to life and 
health are biological problems, and that these problems can be solved 
successfully only by those who have had careful and thorough pre- 
liminary training. As a matter of fact, the physician should be the 
most thorough of all biologists. His knowledge should include not 
only the means of curing disease, but the more important knowledge 
of how to prevent disease. 

There is no such thing as "useless information." All information 
is useful and can be worked into our daily lives as soon as we know 
how to use it, but a few subjects, such as chemistry, physics, anatomy, 
histology, physiology, bacteriology, embryology and pathology are 
absolutely essential to the working biologist, and this the physician 
pre-eminently is. To be of use to the physician he must know these 
subjects as he can only know them by studying them upon a labora- 
tory basis. 

One can easily determine the limits of a physician's education by 
knowing what he considers "practical." Whatever one knows how to 
use is always "practical." ' What he does not know how to use is 
always "theoretical." It is sometimes urged that one may get results 
from purely empirical methods. This is frequently true. With no 
knowledge of bacteriology one may learn to examine sputum, and to 
use Widal's test for typhoid fever, as well as to make many other ex- 



LABORATORY DIAGNOSIS 231 

animations, but knowledge of this kind furnishes no foundation for 
further progress, and the physician who works in this way is certain 
to fall sadly behind his more educated professional brethren. Now is 
the time for osteopathic schools and osteopathic practitioners to unite 
in insisting that their educational standards shall be high. By doing 
this, osteopathy cannot fail to approve itself to an intelligent and pro- 
gressive public, and its future is assured. In every respect the work 
done in our schools must equal or excel that done in the best schools 
of the drug system of practice, and our graduates must be thoroughly 
fitted to fill any public position which representatives of other systems 
are fitted to fill. 



*THE VALUE OF LABORATORY DIAGNOSIS. 

The work of the physician is two-fold. He must, first of all, in- 
telligently diagnose the condition of his patient. Unless this is accu- 
rately done he has no basis for rational treatment. Having diagnosed 
the condition of his patient, his next work is to relieve this abnormal 
condition so far as he can, and assist nature in bringing his patient 
back to a normal condition. 

The work of diagnosis will not unnaturally be conducted in at 
least two places. A considerable amount of it must ever be done at 
the bedside. It is there only that he can gain a knowledge of the 
patient's condition by palpation, observation of the action of the heart 
and lungs ; there only can he get his pulse tracings, observe the tem- 
perature and general condition of his patient. But, in addition to 
these examinations, important as they are, there are yet others which 
shed great light upon the physiological condition or the pathological 
condition of the patient. Among these, and perhaps the two most im- 
portant, are urinalysis and an intelligent examination of the blood. 

It seems absolutely essential to the success of the physician that 
he should have a regular routine examination to which every patient 
is subjected. This routine examination should consist of the bedside 
examinations which have already been mentioned and the blood and 
urine examinations. A careful record of these should be kept, and 
the examinations should be frequently repeated. In this way he 
obtains a real knowledge of the progress which his patient is making; 
and his statement to the patient and to his friends of his condition is 

*Report Cal. Ost. Ass'n, 1903. 



232 OSTEOPATHIC EDUCATION 

removed from the realm of guess-work to the realm of absolute cer- 
tainty. 

Aside from the urine and blood examinations, it is frequently- 
necessary for the physician to make or to have made careful and in- 
telligent examinations of the sputum, of gastric contents, and of fecal 
matter. While in many cases the physician, either from lack of time, 
lack of facilities, or lack of taste, may not care to make these examina- 
tions himself, he should always be able to intelligently interpret the 
reports of these examinations which he may receive from experts in 
this line of work. 

In all of the better grade of medical schools an attempt is being 
made to place the knowledge of the human body upon a scientific 
basis, and osteopaths cannot more certainly discredit themselves in 
the eyes of an intelligent public than by a failure to perceive the im- 
portance of placing all of their work upon an equally scientific basis. 
Every attempt should be made by the profession at large to bring 
such influences to bear upon osteopathic colleges that they will not 
graduate students whose intellectual and scientific attainments are in- 
ferior to the attainments of the better grade of students who are gradu- 
ated from our best medical schools. 



Fourteen years ago osteopathy was an unorganized, inchoate 
method of treating the sick. Today it stands in public estimation shoul- 
der to shoulder with schools of practice which were hoary with age 
before osteopathy was ever dreamed of. 

This wonderful change has resulted from the co-work of practi- 
tioners in the field and teachers in the colleges. Had either of these 
factors been left without the influences of the other, little could have 
been accomplished. The Pacific College recognizes its great indebted- 
ness not only to practitioners in general but to the other schools. 

It has been the constant desire of the college to materially aid in the 
progress which the profession has made and which it is making. 
Several members of its faculty have been active along research lines, 
and each class feels before it completes its connection with the college 
that it has aided in solving some questions the solution of which will be 
of value not only to themselves, but to the profession at large. 



IMPORTANCE OF LABORATORY DIAGNOSIS 233 



*THE IMPORTANCE OF LABORATORY DIAGNOSIS 
TO THE PHYSICIAN. 

The profession of osteopathy is confronted by two evils, of which 
I shall speak briefly. The first one to which I shall refer is the fact 
that there is a decided tendency for people who are sick to get well. 
They will get well if the doctor comes very frequently, and they will 
get well if the doctor does not come very frequently. They will get 
well if the doctor acts wisely, and frequently they get well if the doctor 
acts unwisely. It would seem at first that this is not a misfortune; 
certainly it is no misfortune to the patient; it is no misfortune to the 
individual physician, but to the profession at large it is somewhat un- 
fortunate, as I shall attempt to show you later. The second evil which 
confronts us is the fact that all manipulation, whether skillfully per- 
formed or unskillfully performed, is beneficial in many cases. No 
matter if the physician has very little skill, the fact that he causes a 
relaxation of muscles is beneficial to the patient. 

I say these two facts are unfortunate for the profession, and the 
reason why they are unfortunate is that they lessen the absolute neces- 
sity for the thorough education of the physician. If osteopathy is to 
survive as a system of medical practice, the osteopathic physician must 
be in no wise inferior in his education and training to the representa- 
tives of other systems of practice. There are two duties which a 
physician must perform when he is called to a case.. The first is 
diagnosis. Before he can intelligently apply any system of treatment 
he must know the condition of his patient. When he has ascertained 
this condition, if he is a wise physician, he proceeds to apply such meth- 
ods of treatment as shall tend to alleviate the distress or disorder from 
which the patient is suffering. 

There is no royal road to diagnosis. If we osteopaths are in dan- 
ger from any particular thing more than another, it is the belief that 
there is a right royal road to diagnosis, and that royal road is by 
manual examination. If there is any person here who has more faith 
in the efficacy of the manual examination than I have, the least I can 
say is that he has great faith. I recognize, as I believe you all do, the 
careful hand examination of the patient as one of the most important 
contributions osteopathy has made to the medical profession, and 
what I shall say in the future is intended in no wise to reflect upon its 
great value as a means of diagnosis. It is simply one of them. The 

*Address, St. Louis meeting of Am. Ost. Ass'n, 1904. Pub. Jour. A. O. A., Oct., 1904. 



234 OSTEOPATHIC EDUCATION 

human body is a very complicated organism, and he who undertakes 
to recognize the nature of its abnormal conditions must apply every 
means which is known to science. And before the physician under- 
stands the condition of his patient his treatment can only be based 
upon more or less skillful guess-work; and when he guesses upon a 
scientific question he usually guesses wrong. 

We are all agreed that the manual examination is of prime im- 
portance, but the character of the pulse throws a certain amount of 
light upon the condition of the patient. His temperature tells us some- 
thing of his condition. An intelligent examination of his blood, to- 
gether with an enumeration of the blood corpuscles, tells us something 
in regard to his condition. A carefully made urinalysis tells us some- 
thing of his condition. And under certain conditions a sputum ex- 
amination, a gastric examination and a fecal examination will throw 
still further light upon his condition. 

The point to which I especially wish to call your attention is 
that all of these examinations as indications should be made in study- 
ing the condition of the patient. It is the disgrace of the medical pro- 
fession at the present time that if the patient goes to six different 
physicians he frequently gets six different diagnoses of his condition. 
The reason is that the diagnosis is not made with sufficient care, that 
the condition of the patient is not studied as it should be, and if oste- 
opathy is to rank as it should as the foremost of the schools of medi- 
cine, it must be placed in that position by the scholarly character of 
the members of the profession; and if they possess this scholarly 
character it will be shown in the greater attention which is paid to 
this most important of all subjects, that of diagnosis. 

It is not very unusual to hear the young physician boast of the 
large practice which he has. It is not very unusual for him to tell us 
that all of his time is occupied in the treatment of his patients. As a 
general thing, these statements are not true. But if they were true it 
would be disgraceful; and the only thing which the physician adver- 
tises when he makes such boasts is his absolute ignorance of the worth 
of a physician. If the physician feels the responsibility of his profes- 
sion, if he remembers that human life is in his hands, and then passes 
from one patient to another as rapidly as he can with his mechanical 
treatment, and without studying his patients, and studying them care- 
fully, he is a disgrace to his profession, and he stands in the way of 
its development. 

This morning, in conversation with a physician who is not old in 



IMPORTANCE OF LABORATORY DIAGNOSIS 235 

years but who is old in his profession, a man with the widest experi- 
ence in osteopathy, made the remark that he was cutting down the 
number of his cases, and that every case is receiving more careful 
study. It is from physicians of this kind that advancement of the pro- 
fession is to come. In conversation with physicians I have frequently 
asked their opinion of the value of laboratory diagnosis, and not in- 
frequently the reply has been, "I am not particularly interested in 
those things; I am more interested in the practical side of the work." 
I believe that most of you will agree with me that the difference be- 
tween what most people call "practical" and "theoretical" is that they 
know how to apply the one and do not know how to apply the other. 
Any knowledge which any of us possess which we are capable of 
applying is "practical" ; while all the knowledge which we are not 
capable of applying, all the knowledge which is not connected or linked 
with some other knowledge, is pushed aside and is called "theoretical." 
One of the practical questions which comes to us is how this 
diagnosis is to be carried on. Shall we as individuals attend to it, or 
shall it be handed over to the specialist? My answer on that question 
is, both. The probability is that every physician would do well to carry 
on a certain amount of laboratory diagnosis himself; that every one 
should be equipped so that he can make a urinalysis. Every one should 
be equipped and possessed with sufficient knowledge and skill to be 
able to determine by a sputum examination whether a patient is asth- 
matic, or whether he is suffering from tuberculosis. Within the last 
ten days an examination was made in the laboratory of the Pacific 
College of Osteopathy, which demonstrated very clearly the presence 
of tuberculosis. The patient, a lady, had been treated by four different 
physicians for asthma. It is almost needless to say to you that, however 
good the treatment of these physicians may have been for asthma, it 
must have been very illy adapted to tuberculosis, for I think that most 
of you will agree with me that treatment which may very properly be 
given to the asthmatic patient might produce a most serious result if 
given to one suffering from tuberculosis. And yet, as I said before, 
four different physicians treated this patient for asthma. Do you sup- 
pose that if any one of these physicians had made a careful, intelligent, 
scientific study of that case, such a blunder would have been made? 
If we are to free ourselves from the possibility of making just such 
mistakes — mistakes which are disgraceful to the profession and dan- 
gerous to society — it must be by educating ourselves up to the point 
of utilizing every known method of diagnosis, and intelligently apply- 



236 OSTEOPATHIC EDUCATION 

ing them. In many cases it is undoubtedly best to refer the examina- 
tion to some specialist. There are laboratories in almost all of our 
cities where these examinations can be made accurately, perhaps more 
accurately than can be made by the average practitioner. Still we must 
remember that the urinalysis, sputum examination, fecal examination, 
gastric examination, and all other examinations, no matter how skill- 
fully made, will be of little use to the physician unless he understands 
the meaning of the report ; and if he is going to do this it seems almost 
necessary that he should keep in touch with the work by doing some 
of it himself. 

I cannot close this talk without expressing to you my deep anxiety 
to see osteopathy take its place as one of the leading branches of the 
medical profession, and eventually to supersede all others. If it is to 
take this place, we must educate ourselves for it. Our pride in oste- 
opathy should not be fully satisfied until health officers and sanitary 
inspectors of all kinds may be appointed from our profession, as they 
are appointed at the present time from the other schools. But if they 
are going to be appointed from our branch of the profession, it can 
only be brought about by our thoroughly educating ourselves, by our 
intelligently using every means of diagnosis which is known to sci- 
ence; and when we attend to these things, and when we have placed 
ourselves upon that high educational foundation, when it will be true 
that a degree from an osteopathic college stands for as much as a de-. 
gree from any other college, that it represents as much culture, then, 
and only then, will osteopathy take the place which I feel certain it is 
destined to take. It is our high privilege to work for this end. And 
if we are true to ourselves and to our trust, the goal is not far distant. 



The belief is growing among close observers that much of the 
suffering which patients experience after major operations is due to 
the drugs which the well intentioned, but misinformed, surgeon uses. 
It is suspected by more than one that when the unconscious patient 
receives a "shot" of strychnine to brace up the heart action that he lives 
in spite of the strychnine rather than because of it. 



RELATING TO LABORATORY DIAGNOSIS 237 



*SOME FACTS RELATING TO LABORATORY DIAGNOSIS. 

The following not closely related papers are presented with the 
hope that they will be of practical value to the practitioner. While no 
pretense of originality is made in any case, all of the data given has 
been verified many times over in the pathological laboratory of The 
Pacific College of Osteopathy. 

All thoughtful physicians are feeling the increasing demand of the 
laity for greater exactness in diagnosis, and while the most enthusi- 
astic "laboratory man" would deem it preposterous to claim that any 
complete diagnosis can be made in the laboratory alone, the most con- 
servative among practitioners are more and more availing themselves 
of the aid which can alone come from the technical pathologist. 

MALARIA. 

Most contagious and infectious diseases are caused by vegetable 
organisms (bacteria) which establish themselves upon or within the 
body, but a few diseases are due to parasites whose affinities are clearly 
with the animals rather than the plants. 

Among these parasites the plasmodium malarise enjoys the dis- 
honorable distinction of being one of the most common. Its life his- 
tory is now so well known and methods for its detection are so clearly 
described that the only object of mentioning it here is to call atten- 
tion to the fact that malarial fever may so closely simulate several other 
fevers that it is possible to distinguish them only by means of a blood 
examination. 

It is quite probable that when one becomes infected by the Plasmo- 
dium the infection is practically permanent. Proper habits of life may 
so hold the parasite in abeyance that the patient may suppose he is free 
from them, but if the system becomes debilitated, they at once increase 
in numbers and an attack of malaria results. 

I had an opportunity to make some observations on a case re- 
cently where the patient had an attack of malaria after having been 
free from the disease for seventeen years. The case was at first sup- 
posed to be typhoid fever and it was not until the plasmodium malariae 
was found in the blood that malaria was more than suspected. 

Another case was supposed at first to be puerperal fever, but a 

*West. Ost., Jan., 1908. 



238 OSTEOPATHIC EDUCATION 

careful study of the patient's blood proved it to be malaria. It is for- 
tunate for the practitioner that blood in the form of a thin smear may 
be sent almost any distance for examination by a competent pathologist. 

MOLDS AND YEAST IN THE STOMACH AND BLADDER. 

It has been known for some time that vomitus and urine are 
occasionally infected with molds and yeasts, but I think that the im- 
portance of such infection has not been fully realized. 

Two cases under my observation during the last year were diag- 
nosticated as carcinoma of the stomach by the physicians in charge. 
In both instances the diagnosis was founded upon the clinical symp- 
toms. A careful microscopical examination of the vomitus and stom- 
ach washings of the patients showed large numbers of yeast cells, 
many of them actively dividing, thus indicating that they were not 
merely accidentally present. The further treatment was based upon 
the intention of relieving them from this infection. In both cases the 
improvement was rapid, and the symptoms of carcinoma disappeared. 

In both the foregoing cases the infection was a mixed one. It is 
quite probable that more than one species of yeast was present, and 
aside from the yeast there were two species of mold. One species 
probably was an oidium and the other a penicillium. 

Another case which may prove to be of value along this line was 
a man who suffered from irritation of the bladder. Some of his symp- 
toms were highly suggestive of cystitis, but a careful examination of 
the urine failed to show any pus. There were, however, considerable 
quantities of mold found in perfectly fresh samples of his urine. The 
mold was probably an oidium of some species, and the urine was 
clearly and sharply acid. 

There is no difficulty in understanding how the stomach may be- 
come infected with either yeast or mold, as the spores of these organ- 
isms are ever present in the air, and consequently are ingested with 
both food and drink, and whenever the power of resistance of the 
stomach is sufficiently lowered in any way whatever all of the con- 
ditions favorable for infection are present. The means of bladder in- 
fection are not so evident. It must rarely happen that this occurs 
except by the use of the catheter or sound. It would be difficult to 
emphasize too strongly the necessity for perfect disinfection when 
either of these instruments is used. 



LABORATORY EXAMINATIONS • 239 



-LABORATORY EXAMINATIONS. 

Any pathologist doing general work for the public is likely to be 
asked from time to time to make examinations or perform analyses 
which either require the expenditure of a great amount of time, or 
which are practically impossible. For instance, samples of milk are 
frequently received and the bacteriologist is asked to determine whether 
there are any "'poison germs" in the milk. By this is usually meant 
a request for information as to whether typhoid bacilli,, the bacilli of 
tuberculosis, or other pathogenic micro-organisms are present in the 
samples. 

Now, as a matter of fact, organisms of that kind may be present 
and present in such numbers as to make the milk positively dangerous, 
and yet the most skillful bacteriologist might either be wholly unable 
to prove their presence, or if he should prove their presence it would 
be only by expending many days, and possibly weeks, of time in con- 
ducting his examination. The most careful hygienist places little im- 
portance upon the positive finding of disease-producing bacteria in 
milk or any other food product. If bacteria are present in large num- 
bers, the danger of pathogenic forms being among them is clearly 
recognized. When more than between 500,000 and 1,000.000 bacteria 
to the cubic centimeter are found in milk, it may be positively assumed 
that the milk is unfit for food for infants. It is, of course, possible 
that the number may be very much greater than this and still no patho- 
genic organism be present, but the danger is too great, from a practical 
standpoint, to permit such milk to be used. 

It is not very unusual to receive medicines of various kinds for 
chemical analysis. While it is comparatively easy for the competent 
chemist in a reasonably well furnished laboratory to determine the 
presence and amount of any inorganic compound, it is by no means 
easy to determine the presence of organic compounds. If a question 
is asked as to whether or not a given organic compound is present, 
the matter is comparatively simple, but if no such question is asked, 
the matter of determining just what is present may be difficult almost 
to the point of impossibility. This is due in part to the enormous 
number of possible compounds which may be present, and it would 
readily be seen that one might work for days and might require a 

*West. Ost., April, 1911. 



240 OSTEOPATHIC EDUCATION 

vast amount of the material if he were going to undertake the analysis 
without any clew. To make an illustration, I would say that to send 
an organic compound to a chemist, asking him to determine its nature, 
would be a little like sending a person to a large department store, 
asking him to bring you what you want without giving him the least 
clew as to your particular taste. If it is desired to secure the analysis 
of an organic compound, a direct question should be asked, as, for 
example: Is morphine present in this compound, is cocaine present, 
or any other one or more definite compounds? A question of this 
kind usually admits of a positive answer. 

Smears of pus and other fluids are frequently sent to laboratories, 
with a request that an opinion in regard to them be given. As a 
general thing this is very unsatisfactory, both to the physician and 
the pathologist. If the physician would state plainly what informa- 
tion he desires, the problem would be greatly simplified and the path- 
ologist would be able to render much more satisfactory service. It 
is not unusual for physicians to send sputum and pus to the patholo- 
gist on cotton, in cloth or on paper. Nine times out of ten, when ma- 
terial is received in this way, either nothing can be done or the exam- 
ination is unsatisfactory to both parties. Either the material should 
be sent in a bottle properly corked and labeled, or thin smears on 
cover glasses or on slides should be made. When the material is sent 
on glass it should first be heated nearly as hot as boiling water before 
being sent. This will not only kill the organisms present, but will 
securely fasten them to the glass. Prepared in this way, smears may 
be transported almost any distance for examination. 



The year which is just closing has been very successful from an 
educational standpoint. Never in the history of the college have 
students worked with better spirit, and never has work of a higher 
grade been accomplished. The fact that the work is almost entirely 
upon a laboratory basis makes it, perhaps, somewhat less attractive to 
the superficial student, but it tends to insure the attention and consider- 
ation of that class of students who finally make the profession. 



THE SIDE OF THE COLLEGES 241 



*THE SIDE OF THE COLLEGES. 

The time has come when the profession at large should be deeply 
concerned in regard to the work and the prospects of our colleges, for 
the whole future of osteopathy is dependent upon them. All of them 
have entered upon the basis of a three years' course of study, and 
sufficient time has elapsed to make it possible to have an intelligent 
opinion in regard to the value of the added year's work. It has also 
given us an opportunity to make some observations as to the financial 
effect of this increase in the length of our course. It is very certain 
that some students have been deterred from entering upon the 
study of osteopathy because of the increased length of our 
course. It is almost equally certain that we have drawn in 
some students who would never have studied osteopathy had 
not the course been extended. I am inclined to believe that 
the number excluded is somewhat larger than the number which 
has been attracted by the change from a two years' to a three years' 
course. As the schools are supported almost entirely by tuition this 
has been a burden somewhat heavy to carry. The profession, on the 
other hand, has been greatly benefited by the change as the students 
taking the three years' course are upon the whole superior to those 
who entered upon the former two years' course. It is impossible to 
seriously question the great value of the added year's work. Almost 
every state in re-framing its medical laws requires a rigid examination 
before licensing practitioners of any sort to begin their professional 
careers. These examinations are subject to great variations in the 
different states, but in almost every case a considerable part of the 
examination is upon the scientific subjects which form the basis of the 
physician's education. The standard of these examinations is largely 
determined by the large and richly endowed drug medical colleges and 
it is no easy matter for the osteopathic colleges, supported almost en- 
tirely by tuition, to fit their students to successfully meet these re- 
quirements. However, the fact still remains that no amount of en- 
dowment, and no amount of equipment, will enable the student to 
educate himself without personal effort, and on the other hand the 
most meager surroundings afford opportunities for culture and im- 
provement if the material is wisely used. In other words, what the 
student gets out of a course is much more dependent upon what he 
puts into it than upon equipment or luxurious surroundings. As has 

*Jour. A. O. A., Jan., 1909. 



242 OSTEOPATHIC EDUCATION 

recently been pointed out, the relationship among the colleges is very 
far from being ideal and the colleges themselves find it almost im- 
possible to maintain a proper and dignified relationship with their 
prospective students. The catchy biological term, "survival of the fit- 
test," is so commonly used that we are inclined to accept it as an 
axiom that the most worthy will live. Whether this is true or not is 
entirely dependent upon the standard by means of which we measure 
the fittest. A pollywog will thrive and do well where a canary bird 
would starve to death. A slime mold will luxuriate where a rose 
would be smothered. An educational institution dependent upon 
tuition will survive if it secures a sufficient number of students who 
are able to pay tuition, and the sufficient number is frequently secured 
by adopting a very low standard for matriculation and making it very 
easy for the student to do his work. The school of higher ideals may 
perish while one of lower ideals may survive. 

Briefly stated, competition among unendowed institutions tends to 
lower the educational standard, while competition among endowed in- 
stitutions always tends to raise the educational standard. The first 
survives, if at all, because of the number of its students; the second 
survives because of the quality of its work. 

The practical question, "What can we do to help the colleges?" 
will present itself to the more thoughtful members of the profession. 
Probably the most practical benefit which the practitioner can render 
them is in sending to them thoroughly qualified students. Numbers 
are necessary to make it possible for the colleges to continue their 
work, but quality is almost as necessary as quantity, for unless the 
great majority of students who enter are enabled to fit themselves for 
the exigencies of state board examinations the colleges might as well 
close their doors. 

In conclusion let me clearly call attention to the somewhat 
anomalous position which confronts us. The fate of the profession 
is dependent upon the colleges; the colleges are largely owned and 
controlled by private corporations. The great majority of the mem- 
bers of the profession are unable to understand the far-reaching im- 
portance of the colleges and even in our National Association the vital 
significance of our educational problem is either overlooked or very 
imperfectly comprehended. The profession must arouse itself to the 
recognition of the fact that everything which pertains to the fountain 
heads from which osteopathy is flowing is a matter of vital import- 
ance to every member of the profession. 



A. O. A. AND A. C. O. 243 



*THE RELATIONSHIP BETWEEN THE A. O. A. 
AND THE A. C. O. 

Just what the relationship should be between these two bodies is 
a question by no means easily answered. There is little precedent to 
guide us, and we are making history as we proceed. A wise and sym- 
pathetic relationship between the two organizations will be mutually 
beneficial and a false relationship will be detrimental to both. 

Nothing could be more disastrous to the proper relationship of 
these bodies than the attempt of either to exercise police supervision 
over the other. The A. O. A. is composed of members very few of 
whom have anything more than a friendly interest in the colleges, 
and for the colleges to undertake a policy which would in any way 
control them in their organization would be as unwise as it would be 
disastrous. On the other hand, the colleges have very serious financial 
problems to solve and increasing responsibilities to their alumni, and 
it would be a manifest impossibility for them to faithfully discharge 
these duties if they should suffer any outside body to dictate their 
policy to them. The A. O. A. should at all times use its utmost in- 
fluence in promoting a friendly and sympathetic feeling among the 
alumni of the various colleges. 

The A. C. O. is the organization from which the members of the 
A. O. A. have largely come and from which they will continue to be 
augmented in the future. It would seem that eventually every college 
whose graduates are entitled to membership in the A. O. A. must be 
a member of the A. C. O. It is undoubtedly true that both the colleges 
and the profession earnestly desire to progress and each will have its 
special offering to make to this common cause. The experience of 
the past shows us that a close incorporation, even though it be an edu- 
cational incorporation, is strongly inclined to be conservative. It is a 
fact — explain it how we may — that the best thought in law, medicine 
and theology have been forced upon the professions from the outside 
rather than evolved from the inside. If the osteopathic colleges are in 
a measure safe from history's repeating itself in regard to them, it is 
because they include upon their staffs such considerable numbers of 
active practitioners. The college faculties probably reflect the best 
thought of the profession in the cities in which they are situated. This 

*Jour. A. O. A., Oct., 1909. 



244 OSTEOPATHIC EDUCATION 

is due to a tendency of the leading and most enterprising physicians 
to connect themselves with college work. This being the case, the 
thought of the associated colleges is probably more truly progressive 
than is the thought of the A. O. A. with the college influence 
eliminated. 

The A. O. A. has probably made a mistake in appearing to re- 
gard with some suspicion those who are devoting their lives to teach- 
ing and repleting the ranks of the profession. It seems to be an un- 
written law in the A. O. A. that teachers in osteopathic colleges shall 
be excluded from all positions of honor. The only justification for 
this course is the fear of exciting jealousy among the colleges. 
Whether this fear is sufficiently well founded to make it wise to ex- 
clude from all official positions the men and women who are making 
the colleges, is an open question. With all respect for the A. O. A. 
as an organization, the fact still remains that its rank and file is com- 
posed and must be composed of practitioners whose minds are so ear- 
nestly occupied with the details of their practice that they have little 
time for serious consideration of the broader and deeper problems re- 
lating to the profession, and are thus not so well fitted to pass upon 
questions of this kind as are those whose college work forces them 
into consideration of these questions. In other words, I believe that 
the A. C. O. may justly claim at the present time to be the leaders in 
professional thought. 

Nothing is more natural for the professional man or woman than 
to remain in substantially the same intellectual condition he was in 
when he left his college. In his natural and laudable desire to be loyal 
to the institution which has fitted him for his life work, he is in danger 
of confining his loyalty to the ideas which were presented when he 
was a student, rather than to the spirit of the institution. 

Members of the A. O. A. must remember that the colleges are 
each taking steps forward and that their loyalty must be a loyalty to 
the spirit of progress rather than a loyalty to the special views which 
were taught when they were students. It is humiliating to the pro- 
fession to know that their colleges stand upon an insecure foundation. 
Such, however, is the truth, and one of the first steps which should 
be taken by the profession at large is to secure the endowment of the 
colleges. The A. C. O. should find in the committee on education of 
the A. O. A. a body of wise, clear-sighted men, men of wide experi- 
ence in legislative affairs, men of long experience in practice, men of 
thought and originality, whose consultations and suggestions should 



A. O. A. AND A. C. O. 245 

be of great value in determining the curriculum and the requirements 
of the colleges. 

Lastly, both organizations should recognize the fact that in union 
there is strength; both should be governed by the wisest and most un- 
selfish, devoted to the common cause; neither should, under any con- 
ditions, undertake to exercise snap judgment upon matters of mutual 
interest; neither should ever resort to the arts of the demagogue in 
making an appeal to popular sentiment. Great questions never have 
been, and never can be, settled by majority vote. Strange as it may 
seem, it is nevertheless true, that a majority is generally wrong. Where 
the leaders of thought stand today the rank and file will stand to- 
morrow, but tomorrow the leaders will not be standing where they 
stand today; they will have advanced to new heights. Any move- 
ment worthy to live is an advancing army, with the officers riding far 
in advance. 



The world moves, and it is necessary that educational concepts 
should move. Those who are not carefully watching the educational 
trend of matters are in great danger of fearing that progressive 
changes are leading the colleges away from the osteopathic concept. 
Let us remember that the osteopathic concept is growing. As has been 
so often said, the moment we cease to grow, we cease to live. The 
changes which are made in our osteopathic colleges and in their 
curriculi from time to time are in the line of progress and develop- 
ment, and are necessary to enable us to adjust ourselves to the grow- 
ing, developing world. 

The osteopathic colleges started as virtually sectarian institutions. 
By that I mean they stood for one thing, and practically one thing 
only. They are developing into non-sectarian institutions. That does 
not mean that they are less loyal to the original idea, but it means that 
in order to turn out full fledged physicians who are able to meet such 
emergencies as arise in the daily practice of the physician, it is neces- 
sary for the student to be educated in many things in which the earlier 
practitioners were not educated in their schools, but in which they 
have been obliged to educate themselves in their offices. 



246 OSTEOPATHIC EDUCATION 



*EDUCATIONAL STANDARDS. 

Our drug medical friends are so persistently spreading the report 
that we are trying to lower educational standards that we feel it only 
just to give to the world the educational views held by this journal. 

We believe most heartily in the proper inspection of school children 
and in everything that makes for good public and private hygiene. 
We do not believe that all knowledge of these subjects must necessarily 
be derived from training received in an allopathic medical college. 
We believe that the inspection of school children is primarily for the 
benefit of the children and not for the aggrandizement of any special 
system of medical practice nor for the financial benefit of physicians 
who are employed to do the work. We believe that when a person is 
employed for any kind of public work, the first requirement should be 
efficiency along the particular line for which he is employed. Specific- 
ally, we believe that if an inspector is to be employed for the schools, 
no inquiry should be raised as to the particular sect of the medical 
college from which he graduated nor, in fact, should any question be 
raised as to whether he graduated from any medical college. The only 
question should be, is this person scientifically and morally fitted to 
make the examinations which are necessary for the welfare of the 
child himself and for those who are brought in contact with him? 

If this test were applied, it would not hurt us in the slightest de- 
gree if every appointment went to allopathic physicians. Should this 
be the case, it would only mean to us that our own people must bring 
themselves up to a higher educational standard; but when these ap- 
pointments are made on the ground that a physician belongs to a 
special system of practice, we protest both from a professional stand- 
point and from a standpoint of citizens and taxpayers. 

The violent struggle made by the allopathic physicians of Los 
Angeles for a controlling interest on the school board shows us that 
a fight which has been largely submerged is now coming to the sur- 
face. It is, we believe, a fight which we can easily win if we make 
ourselves worthy of winning it. To do this, our educational stand- 
ards must be fully equal to the standards of the allopathic physicians. 
The result of State Board examinations convinces us that a number 
of our colleges have already reached this standard. It now remains 
for them to forge ahead and, as soon as it shall be known that our 

*West. Ost., Nov., 1911. 



STATE UNIVERSITY AND MEDICAL COLLEGES 247 

people are as broadly educated as are the drug men, our success is 
assured. The people at large are sick of drugging. The allopathic 
physician is being discredited and a goodly inheritance is ours if 
we can maintain a high educational standard and can honestly seek 
the good of the public rather than our own immediate interests. 



*THE STATE UNIVERSITY AND THE MEDICAL COLLEGES. 

It is authoritatively stated that the State University has formally 
adopted another medical college. Just what the brand of "medicine" 
taught by this college may be is a matter of very little moment, but it 
is a question of far-reaching importance as to whether or not the State 
should select some special brand of the healing art and give to that 
special brand the prestige which naturally comes from state patronage. 
It is quite within the province of the State University to give instruc- 
tion in anatomy, physiology, bacteriology, histology, pathology, and all 
other branches which are founded upon definite knowledge, but it is 
as unwise in the present state of medical science to give instruction in 
therapeutics as it would be to give instruction in theology. Were either 
of these subjects presented under the head of "philosophy" or in 
the department or departments devoted to the so-called "humanities," 
no just criticism could be offered ; but when the State definitely teaches 
that some particular system of therapeutics is correct and that the use 
of certain drugs is necessary for the alleviation of suffering, a great 
wrong is inflicted upon other systems of therapeutics which perhaps 
rest upon an equally solid foundation. 

Never in the history of medicine has there been a wider range of 
honest opinion than there is at the present time, and it is needless to 
say that this great variation of opinion indicates the uncertainty of all 
of our systems. Not only is the whole science of medicine undergoing 
rapid changes, but every individual system is in a chaotic state. To 
sieze upon one of these systems and undertake to crystallize it is, of 
course, to arrest its own power of development, and this system is in 
danger of becoming a conscious or unconscious persecutor of other sys- 
tems. All broad-minded thinkers are agreed that few things are more 
detrimental to religious development than a state church, and all of the 

*West. Ost., July, 1909. 



248 OSTEOPATHIC EDUCATION 

evils which can be pointed out in regard to a state church apply with 
equal force to state medicine. When therapeutics shall become an ex- 
act science, then, and only then, will it be safe for a State university 
to conduct a medical college. If we had some system of theology which 
could be demonstrated with absolute scientific exactness, it assuredly 
would not only be proper, but highly desirable, that this system should 
be taught at public expense; but, recognizing as we do the utter lack 
of scientific foundation for our theological systems, we wisely exclude 
that subject from our public school curriculum, and, as I above stated, 
the reasons for the exclusion of therapeutics are quite as valid. 



The Southern California Practitioner for August, 1913, contains 
a letter from Dr. F. E. Moore of Portland, Oregon, in which Dr. Moore 
tells of the necessity of the Osteopathic physician concealing his sys- 
tem of practice if he desires to enjoy the advantages offered by 
European hospitals, and then the Practitioner inquires : "How would 
you like to be a D. O. ?" 

In answer to this question of our contemporary, we will say that 
we are very glad to be D. O.s. That even if we had no better system 
of practice than have our drug friends, we would still rather be 
D. O.s, and suffer the limitations which the American Medical Asso- 
ciation in Europe inflicts upon us, than to be the bigots who inflict this 
inconvenience. If we read the history of the world aright, bigotry 
never has accomplished its purpose, and if our M.D. friends suppose 
that they can seriously injure Osteopathy by petty persecutions, we 
simply desire to tell them that they are mistaken. John Calvin suc- 
ceeded in burning John Huss at the stake, but no intelligent person 
would now think of undertaking to defend the views of John Calvin, 
while the views of John Huss have gone far toward changing Europe 
from barbarism to civilization. 

Whatever our drug friends have in the art of healing diseases that 
is true, will live, and they need not persecute others to make it live. On 
the other hand, whatever they have which is fallacious will die in 
spite of all that they can do to prolong its life. 

Whatever may be true in Osteopathy will live in spite of all our 
drug friends can do. Whatever is untrue will die of its own weight, 
and the sooner the better for all of us. 



THE INDEPENDENT VS. THE UNIVERSITY 249 



THE INDEPENDENT COLLEGE VS. THE UNIVERSITY 

COLLEGE 

The man or woman who has decided to become a physician finds 
a problem which is at once of the greatest importance and the greatest 
difficulty. There are so many colleges offering valuable courses that 
the wise selection of one of them requires much study. Many of our 
leading universities maintain medical colleges, and at first thought one 
might conclude that these would offer advantages which are superior 
to those offered by colleges not thus supported. For a certain class of 
medical education this is probable true ; for another class it is certainly 
not true. The student who desires to fit himself to act as health officer 
in the larger cities, as quarantine inspector at seaports, or as sanitary 
engineer to grapple with the larger problems of preventive medicine, 
will find splendid opportunities in the medical colleges associated with 
the great universities ; to the student who wishes to fit himself for the 
w r ork of a physician, for the care of the sick and the personal super- 
vision of the health problems of the family and the community, the 
smaller colleges offer surpassing advantages. 

In the smaller colleges, the teachers are, for the most part, them- 
selves professional men and women. They are constantly meeting the 
problems presented by the emergencies of the sickroom and the idiosyn- 
crasies of the people in it ; of the health office, of the sanitary laws, and 
of the need for watchfulness for beginning epidemics. Students who 
come into intimate, daily association with teachers who successfully 
meet these problems must receive the best possible preparation for 
dealing with such conditions in their own practice after graduation. 

On the other hand, this close personal association compels con- 
stantly higher ideals on the part of the teachers. Students who know 
their teachers intimately demand the highest scholarship, the purest 
professional ideals, and the strongest and finest personal characteristics. 
While the strictly technical training of the teachers in the great univer- 
sities may be unexcelled, the teachers in the smaller colleges have 
usually the greater power of developing the broad intelligence, the im- 
mediate efficiency, and the practical common sense which are of first 
importance in meeting the requirements of professional success. 



250 OSTEOPATHIC EDUCATION 



^DEGREES. 

As the osteopathic profession has been agitated over the question 
of degrees for the last two years, it has occurred to me that a brief 
history of degrees might not be without interest. 

The ancestral form of the modern degree had its inception in a 
desire to preserve the purity of theological teaching, and no one was 
allowed to call himself a master or doctor (both of which terms orig- 
inally meant teacher), until his qualifications had been passed upon 
by a bishop or the chancellor of a cathedral. The possession of either 
of these titles, duly attested by a bishop or the head priest of a cathe- 
dral, was regarded as evidence of the purity of the teacher's theology 
and a guarantee that he would not seriously mislead those coming 
under his instruction. As cathedrals and monasteries became centers 
of theological instruction as well as places of devotion, young men 
were drawn to them for educational purposes and the beginning of 
organization was not among those giving instruction, but among the 
students themselves, and it appears to have been for the purpose of 
guarding themselves against the extortions to which strangers were 
commonly subjected in medieval cities. As these student guilds be- 
came larger and more thoroughly organized they not unnaturally 
attracted public attention, and it very soon became a settled policy 
that degrees should be granted to their members only on authority 
bestowed by the Pope, some emperor or king. 

By the year 500 A.D., the old Roman schools were for the most 
part dead and universities were springing up around the cathedrals 
and monasteries. The first division of educational subjects was made 
for the purpose of differentiating the instruction given the priests 
from the instruction given the monks. Gradually the instruction be- 
came more secular in character and by the year 900 x\.D., this division 
of subjects had proceeded to such an extent that in several seats of 
learning four faculties were recognized. These were the faculties of 
theology, the arts, medicine, and the law. 

The first medical faculty known to have been organized was that 
of Salerno, Italy. It is perhaps not digressing too much to say that 
Salerno owes her precocity largely to the influence of Saracen 
physicians, who settled in Southern Europe at an early day. Up to 
this time degrees were granted to those who showed special aptitude 

*Jour. A. O. A., April, 1911. 



DEGREES 251 

for teaching, and simply meant that the possessor had the authority of 
his university to give instruction. Up to the thirteenth century, no 
clear distinction was recognized between the master and the doctor, 
but about that time the degree of doctor came to have a higher sig- 
nificance than that of master. The term doctor, as used until about 
1500, was generally followed by an adjective giving some character- 
istic of its possessor, such as profundus (learned), angelicus (angelic), 
and others. At this time, that is at the beginning of the sixteenth cen- 
tury, the school in arts or philosophy extended through four years of 
time. The course in law extended through seven years of time; the 
course of medicine through eight years, and the course in theology 
through fourteen years. This seems to us at first to have been time 
for rather extensive instruction, but when we remember that students 
did not, as a general thing, possess the art of reading when their in- 
struction began, and that they were for the most part a self-support- 
ing body during the time they were receiving instruction, we need not 
suppose that their knowledge was any too profound at the time of 
their graduation. 

It was not until some time in the seventeenth century that our 
modern college degrees came into general use. If the term "Bachelor" 
was used at all in the earlier institutions of learning, it simply desig- 
nated a student, but with the rise of the universities of England to 
secular educational institutions, rather than monastic institutions, our 
modern degrees came to have well-defined meanings. In the depart- 
ment of arts or philosophy, he who completed the prescribed course, 
was given the degree of Bachelor of Arts. He who pursued the sub- 
ject somewhat more extensively, was admitted to the degree of Master 
of Arts, and he who by diligence fitted himself to give instruction, re- 
ceived the highest academic title, that of Doctor of Arts or Philosophy. 
Our more modern academic degrees of Doctor of Science, Doctor of 
Music, or Doctor of Zoology, etc., appear to have originated within 
the last 150 years. I have not been able to find evidence that the de- 
gree Doctor of Medicine was used in the modern sense of the term 
until about the year 1350. From that time on it seems to have been 
granted more or less frequently by the faculties of medicine in Euro- 
pean universities, and before the Pilgrims landed on Plymouth Rock 
it was the badge of the professional physician. 

As the early European universities were entirely separate from 
each other, and as there was little tendency for professors to pass from 
one to another, it naturally followed that their teachings were extremely 



252 OSTEOPATHIC EDUCATION 

inharmonious, and physicians educated at one school had very different 
ideas in regard to the nature and cause of disease from those educated 
in some rival school. 

It was not, however, until some time in the eighteenth century that 
any special animosity existed among the different schools, and it was 
not until late in that century that it appears that anyone attempted to 
secure laws antagonistic to those holding opinions inharmonious with 
his own. In Hungary and Spain, medical teachings seem to have been 
specially sane, and the osteopath who reads the views of many of the 
Spanish and Hungarian physicians cannot fail to see in their philosophy 
views singularly in harmony with his own. As has been before stated, 
all these physicians, notwithstanding the extreme diversity of their 
views, were designated by a similar title or degree. In fact the osteo- 
paths are the first division of the medical profession who have deemed 
it wise to distinguish themselves by a special title. 

If it is true that the Allopathic physician is intellectually a descen- 
dant of German and English physicians distinguished by the title of 
Doctor of Medicine, it is also true that the osteopath is the intellectual 
descendant of the Spanish and Hungarian physicians who had the same 
degree. There are still some osteopathic physicians who appear to be- 
lieve that the system of therapeutics which one follows is in some way 
dependent upon the special degree which he holds. It is, of course, 
needless to say that this not true. Degrees have very largely lost their 
importance in modern education. Some of the ablest university pro- 
fessors have, for reasons satisfactory to themselves, never cared to take 
more than the Bachelor degree, while they have signed diplomas con- 
ferring the degree of Doctor upon numerous students. Forty years 
ago there was a decided tendency to increase the number of degrees, 
and every little college at the cross roads was devising and granting 
new degrees to its graduates. At the present time the tendency of all 
the more dignified institutions is to decrease the number of degrees. 
The degree Bachelor of Science is likely to be eventually discarded for 
the older degree of Bachelor of Arts. This does not mean, however, 
that the instruction formerly given to attain the B. S. degree has been 
dropped, nor does it mean that science will be less cultivated by the B. 
A. than it was by the B. S. 

It may be that we as a profession shall continue to deem it best to 
hold our extremely protestant position and continue our special degree 
with all of the advantages and disadvantages accruing therefrom, or it 
may be that we shall eventually find it best to use the degree which has 



DEGREES 253 

so long stood for the medical practitioner. In neither case will it mean 
the slightest surrender of our special system of therapeutics. The 
medical doctor of Hungary depended upon mechanical stimulation, 
exercise and diet, just as honestly as the medical doctor of Germany 
and England depended upon the powder of crushed toads and the 
decoction of ill-tasting plants. 



Degrees are a kind of relic of the Middle Ages which have lived 
down to the present time and that they are becoming as much of an 
anomaly in our modern educational system as a pterodactyl would be 
were that beast to appear in a modern zoological garden. The modern 
student who is worth anything works for knowledge rather than for 
the privilege of appending letters to his name. Then, too, we believe 
that the idea of requiring a long period of training to attain 
to the dignity of his higher degrees are wrong from a psychological 
standpoint. It seems that the human mind is so constituted that it 
cannot spend long years in learning what other people think and still 
preserve very much power for original thought. It is a well-known 
fact that many of the truly great men and women of the world have 
been absolutely without college training and many of the great think- 
ers who have been college bred were not regarded with high favor by 
the institutions from which they graduated. All of this strengthens 
our conviction that long-extended courses of study educate all of the 
originality out of the student. At the end of these long courses he 
may know wonderfully well what others have thought, but he is ill 
prepared to do very much thinking for himself. 



There is always danger that when a speculative subject is sup- 
ported by the general Government it will crystallize into hard and fast 
dogmas. When this occurs, it not only prevents the progress which 
every science should make, but it becomes more or less of an oppressor 
of other systems of thought. Neither a State religion, a State medi- 
cine, nor a State sociology is at all compatible with the progress which 
a free people must continue to make. 



254 OSTEOPATHIC EDUCATION 



*STATE BUREAU OF HEALTH. 

A statement is being widely circulated through the State that 
an effort will be made this winter to secure a law providing for a 
State Bureau of Health. 

On its face, a law of this kind seems most beneficent, as under 
its provisions physicians would be appointed to examine children in 
the public schools, and to advise or even compel parents to secure 
such treatment for them as their condition would indicate to be most 
beneficial. The State Bureau of Health would also have general 
supervision of all sanitary matters in the State, and would largely 
do away with the need of much of the personal care and attention 
now given by individuals to health problems. 

We say that on its face all of this seems beneficent, but when 
we look below the surface there are at least two objections which 
manifest themselves. The first is that too great paternalism on the 
part of the Government always results in the degradation of the 
people. If people were protected from the folly which they might 
learn to avoid by experience, the world would soon be filled with fools. 
Good hygiene, both public and private, is of immense value, but if it 
is purchased at the expense of individual exertion and individual devel- 
opment, valuable as it is, we have purchased it at too high a price. 

The second objection is that we are in serious danger of com- 
mitting to the central government those duties which should be per- 
formed by the local government. From a financial standpoint, cen- 
tralization is unquestionably beneficial, but he who sells liberty for 
money makes a poor exchange. The tendency of all of this is to estab- 
lish a State school of medicine, and should this be done it would prac- 
tically put an end to medical progress so long as such a law remained 
in force. We want no State medicine and no State religion. We have 
no thought that a State-directed system could long be permanent 
among liberty-loving people, but it will be vastly more to our credit to 
refuse to allow such a system to be organized, than to permit the 
shackles to be placed upon us, and afterward free ourselves from 
them. We believe most strongly in public hygiene and in private 
hygiene, but we believe in the administration of public hygiene by the 
local government rather than by the State. 

We cannot be unmindful of the fact that the United States Marine 



*Ed., West. Ost., Jan., 1911. 



STATE BUREAU OF HEALTH 255 

Service represented California as being in very much greater danger 
of bubonic plague than she really was. It is an extremely difficult 
matter to get at the real truth of the situation, but it is only fair to say 
that there are some very well-informed people who seriously question 
there having been one case of bubonic plague in California, and no 
one can be a very profound bacteriologist without knowing that there 
are bacilli corresponding so closely to the organism which produces 
bubonic plague as to make the distinction between the two extremely 
difficult. 

No matter how beneficent a system may be in its incipiency, it 
becomes dangerous when it is fully organized, and we believe that 
the real interests of the public and the honest advancement of the 
science of medicine are both largely dependent upon local control of 
public hygiene rather than to allow this important matter to be organ- 
ized into a State system. 



If there is one subject above another which is chaotic at the pres- 
ent time it is that of therapeutics, and for us to voluntarily limit our 
development along that line seems to me to be a mistake for which we 
will have little excuse to offer in the future. I am heartily in sym- 
pathy with those who believe that the use of drugs is an error, and a 
most serious one, too. There are, however, a number of therapeutic 
measures which possess more or less value, and these are the heritage 
of the medical profession. They belong to the drug system of prac- 
tice no more than to osteopathy, or to any rational system which may 
be developed in the future, because they are in harmony with the laws 
governing cell life. In this class belong all measures of public and 
personal hygiene, asepsis and antisepsis and the use of anesthetics 
under certain conditions. 

In saying this I do not mean to encourage the idea of making 
osteopathy a hodge-podge. It seems to me that we should use what- 
ever therapeutics we find necessary to give every cell in the body, as 
well as the body itself, a normal environment. This must include also 
the means necessary for the removal of foreign substances or abnormal 
tissues which interfere with the proper working of the body. 



256 OSTEOPATHIC EDUCATION 



HYSTERICAL FEAR OF PARALYSIS 

We have recently been treated to a somewhat hysterical alarm of 
infantile paralysis in California. We do not seriously question there 
having been a number of cases in Los Angeles, and probably in other 
cities, but we do not believe that every case which has been diagnosed 
as infantile paralysis has been a case of that dread disease. 

Intentionally or unintentionally, a number of physicians have 
worked up a needless and senseless hysteria on this subject. These 
hysterical fears should be frowned upon by all intelligent people. It 
is by no means easy to estimate the harm which comes from things 
of this kind. In their senseless fears, people are led to do the very 
things which most predispose them to the disease which they are 
seeking to avoid. 

We are heartily in sympathy with regulations which shut chil- 
dren out of theaters and other crowded and more or less imperfectly 
ventilated rooms, but we believe it a great mistake to shut them out 
of parks and places of recreation, where they are in the sunshine and 
fresh air. We are especially opposed to arousing a fear on the part 
of the public, which is so easily commercialized by the profession 
which originates it. 



We have not yet passed that stage of mental development where 
there is a feeling in the minds of many people that diseases are "sent" 
in some mysterious way. Even the responsibility for accident is often 
condoned by the assurance that the seeming misfortune was "sent" for 
some ultimate good. 

If there is any lesson which we need to learn more than another 
it is that we live in a world of cause and effect; that from a stand- 
point of health, at any rate, there is no such thing as vicarious 
atonement; that disease comes as the result of a violation of the laws 
of our beings, and that disease can only be prevented by a thorough 
understanding of the causes of disease and an intelligent avoidance 
of those things which produce it. 



NOTES 257 



NOTES. 



Young people now entering mature life must recognize the fact 
that the work of the modern physician is, and must be, quite different 
from the work of the physician in the past. Until recently it was sup- 
posed that sickness and disease were inevitable. Now we are finding 
that the greater part of sickness is entirely unnecessary and that, with 
proper public and personal hygiene, it may be avoided. Hospitals must 
be maintained not for the benefit of a staff of physicians but because 
they minister to public needs and if the free dispensary answers a real 
public need, it will exist no matter how detrimental to physicians it 
may be and physicians must simply learn to accommodate themselves 
to these new conditions. 



A little while before the opening of each term some, and perhaps 
all, of our osteopathic colleges receive letters from practitioners scat- 
tered over the country saying that they have prospective students whom 
they can influence as to the college which they shall attend and asking 
for "bids" for these students. It is needless to say that no self-respect- 
ing educational institution can or will make a bid on any such proposi- 
tion. No college should receive a student until there is some reason 
for believing that he may successfully complete the course. To do 
otherwise is to commercialize college work beyond all endurance. The 
colleges must necessarily depend upon practitioners in the field for find- 
ing suitable students for them, but the most that the practitioner 
should do is to notify the college of the prospective student and tell 
the prospective student of the college so that they may get into mutual 
correspondence. 

The time has come when we have got to consider very carefully 
the qualifications of those who are to enter the Osteopathic profession. 
Schools are not, and cannot be, money-making institutions. All educa- 
tional institutions are money consumers and the day is not far distant 
when our colleges will have to be at least partially supported either by 
their alumni or by special endowment. When a practitioner finds a 
person who would be likely to be of value to the profession he should 
be patriotic enough to help to get him into the best college with which 
he is acquainted and this should be done without thought of private 
gain. 



258 OSTEOPATHIC EDUCATION 



*FEE-SPLITTING. 



One of the most dangerous and insidious of the faults of our drug 
medical brethren has been imitated to some extent by physicians of 
our system of practice. We refer to the acceptance of commissions 
which are offered by surgeons and other specialists. 

The more conscientious of the drug medical journals are crying 
out against this evil, and we believe that our own branch of the pro- 
fession should draw back ere their hands become seriously contami- 
nated by these base bribes. Unfortunately we have not a copy of med- 
ical ethics at hand, but we fearlessly assert that true ethics requires 
that the physician have no transactions with the specialist with which 
the patient is not fully cognizant. With human nature as it is, it is 
utterly useless to talk of a person's possessing perfectly unbiased judg- 
ment when there is a rich bribe ready for him if he shall decide in a 
certain way. Unconsciously to himself, the prospective commission in- 
duces the physician to advise operations from which he otherwise 
might strive to save his patient. 

Like most other ills, this method of doing business is something 
of a boomerang to the physician employing it, for the surgeon, well 
knowing that he will be obliged to divide his fee, charges much more 
than he otherwise would, and in that way the patient, consciously or 
unconsciously, aggrandizes the surgeon to whom he pays the big fee at 
the expense of his physician to whom he has been in the habit of pay- 
ing much less. 

As we see it, the physician is entitled to compensation for what- 
ever services he renders his patient; he is entitled to compensation for 
the examination which indicates the necessity of surgical or other 
special treatment; for such assistance as he renders the surgeon at the 
time of the operation ; and for the after care of the patient ; but we be- 
lieve the dignity of the physician should forbid his acting as a mere pro- 
curer for the surgeon. In other words, let the surgeon have his pay for 
services rendered, and let the physician have pay for services rendered, 
and let the relationship be such that the patient may know everything 
connected with the business. We fully believe that the physician is 
treading on very dangerous ground when he engages in any kind of a 
transaction which will not bear the light of publicity. 



*West. Ost., April, 1911. 



EARLIER RESEARCH WORK 259 



*EARLIER RESEARCH WORK. 

It may not be without interest when the air is full, as it now is, 
of research work to say a few words about the earlier attempts in this 
direction. It is quite possible that some work, of which I have no 
knowledge, was done in the early days. 

The first real work, so far as I know, was done by Dr. D. L. 
Tasker at the Pacific College of Osteopathy. This work was reported 
in the Osteopath, a journal then published by the College. His report 
appeared in the August number of 1901. The title of the article was 
"Pulse Tracings," and it was illustrated by three engravings showing 
the effect upon circulation of stimulation of the vagus nerve. Dr. 
Tasker concluded his description of these experiments by the state- 
ment: "The character of the pulse shows a wonderful influence has 
been exerted on the heart." 

The next recorded work which I have been able to find was done 
in the year 1905. In this year three valuable papers appeared. One 
was a partial report of experiments upon visceral reflexes. This paper 
was by Dr. Louisa Burns and was published in the "Osteopathic 
World/' of Minneapolis, in August, 1905. This report, although brief, 
was indicative of the great amount of work which Dr. Burns was doing 
at that time. Her conclusions were founded upon experiments made 
upon about thirty cats and dogs. Among the conclusions reached were 
these : 

"Mechanical stimulation in the lower dorsal region initiates peris- 
talsis and vaso-constriction in the stomach and intestines, while deep, 
steady pressure in the same region relaxes the muscles both of the 
stomach and intestines and their blood vessels." 

"Stimulation of the pneumogastric nerve initiates vaso-constriction 
and peristalsis in stomach and small intestines." 

"Gentle stimulation applied directly to the walls of the stomach and 
intestines produces normal peristalsis under normal conditions." 

"After section of the splanchnic nerves gentle stimulation of the 
walls of the stomach or intestines almost immediately produces the 
most violent peristalsis." 

"After section of the pneumogastric stimulation directly applied 
to these structures was followed, after a perceptible latent period, by 

*Jour. A. O. A., June, 1911. 



260 OSTEOPATHIC EDUCATION 

the inhibition of any peristalsis already present, then by reversed peris- 
talsis. Bile was sometimes found in the stomach after this experiment." 

The same year that this report appeared Dr. J. J. Pierce, then of 
San Francisco, read a paper before the meeting of the California State 
Association on some visceral actions obtained by manipulation of the 
cerebro-spinal nerves. This paper was founded upon a series of care- 
ful experiments carried out by Dr. Pierce. His own statement is, "I 
have used various small animals — rabbits, cats and dogs — but mostly 
rabbits on account of the ease of handling. The operations are pain- 
less, the animals being anesthetized beforehand." Dr. Pierce especially 
emphasized the importance of his experiments from a practical stand- 
point. The value of these experiments as they appeal to him were as 
follows : First, "Confidence that one may obtain definite action over 
certain nerves and centers by manual means ; second, knowledge of the 
effect upon visceral action of irritative, destructive or inhibitive lesions 
upon the course of such nerves or centers as control the organ in ques- 
tion ; third, a means of effectively demonstrating that osteopathic pro- 
cesses are scientific and can be proven." 

As before stated, Dr. Pierce's paper was presented before the 
State Association of California. The National Association that year 
was held in Denver and at this meeting Dr. Carl McConnell delivered 
a stereopticon lecture illustrative of the original work which he was 
doing. It is probable that Dr. McConnell's photographs were the first 
ever made showing the effect of bony lesions upon the organs of the 
body. I regret that I cannot, at the present moment, place my hand 
on Dr. McConnell's report, but I well remember that those of us who 
listened to his masterly report felt that osteopathic principles were so 
thoroughly demonstrated by his work that we are not likely to lose faith 
at any time in the future. 1905 was certainly a great year for us. 

The next matter of original research was on the question, "Which 
weighs the most, the egg or the chicken which comes from the egg?" 
The experimentation in this case was carried on by Dr. John O. Hunt, 
then a student in the Pacific College, and myself. The result was pub- 
lished in the bulletin of the Southern California Academy of Sciences 
in December, 1906. As a result of these experiments it was found that 
a sterile egg kept in the incubator by the side of a fertile egg lost 
lSy 2 % of its weight. The chick hatched from the fertile egg weighed 
29.65% less than the egg at the time of the beginning of incubation. 
In a second experiment the unfertilized egg lost 17% of its weight, 



EARLIER RESEARCH WORK 261 

while in an egg from which a chicken developed the loss was 20% of 
the original weight. 

Since 1906 research work has been vigorously prosecuted. It 
is highly probable that previous to that time considerable research work 
had been done, but I have not found it reported in the periodicals to 
which I have had access. 



From its earliest days the Pacific College has emphasized the im- 
portance of the laboratory side of the physician's education. This has 
been true to such an extent that it may be truthfully said that the history 
of the scientific development of this college is the history of the scien- 
tific development of osteopathy. Few of the osteopaths of the present 
day are aware of the small value which the early osteopaths placed upon 
scientific training. The truth is that at one time it was necessary to 
explain and almost apologize for work of which we are all proud today. 



It is probable that the rank and file of the profession are very 
much more interested in the application of the fundamental principles 
upon which osteopathy rests than in the development and discovering of 
these principles. This of course is perfectly natural, but the thought- 
ful members of the profession must ever keep in mind the fact that 
our advancement is entirely dependent upon the solidity of our funda- 
mental principles. Give each one of us a thorough knowledge of the 
human body and the professional side of the work will largely take 
care of itself. 



It seems to us it would be better if the members of the profession 
should always use the term Osteopathy as meaning a philosophy rather 
than as the name of a special kind of manipulation. As a philosophy 
Osteopathy includes all methods that can be used to surround a person 
with proper environment, internally and externally, so that the func- 
tioning of the body may be restored from an abnormal condition to a 
normal condition and in that way the patient helped from a condition 
of sickness into a condition of health. 



PART IV. 
Articles of General Interest 

*THE THERMOMETER. 

Among the many instruments of precision which the modern 
physician uses in his routine practice, none is of more practical value 
than the thermometer, and perhaps among them all there is no instru- 
ment of whose history the ordinary practitioner knows less. This is 
not at all unnatural when we consider the fact that the generation 
which first knew of the thermometer were gray headed and decrepit 
with age when the Pilgrims landed on Plymouth Rock. 

The first thermometer, so far as we know, was invented about 
1575. This thermometer was what is now known as an air ther- 
mometer, and consisted of a glass bulb with a long, tubular stem. 
When the bulb was warmed so as to expel some of the air and the open 
end of the stem placed beneath the surface of water, the water was 
forced up the stem as the bulb cooled ; and if the room became warmer, 
the expansion of air in the bulb would force the water in the stem 
downward; and if it became colder, the contraction of air in the bulb 
would permit the water in the stem to be forced somewhat higher by 
atmospheric pressure. 

It will readily be seen that by means of this somewhat crude in- 
strument it would be possible to determine the relative temperature 
of rooms; and by marking the place where the water stood in the 
stem at a given time, it would be possible to determine whether the 
room was growing warmer or colder. This instrument was invented 
by a Hollander by the name of Drebbel. 

It was only a few years later that some one, it is not now known 
who, invented a thermometer the form of which closely resembled 
our modern instrument, using alcohol as the expanding substance. 
By means of this thermometer it was possible to compare the tem- 
perature of one person with another. It is probable that the physicians 
connected with the medical college in Florence, Italy, were the first to 
use the thermometer as a clinical instrument. While we have no 
definite information as to just the time that this was done, we are 
probably safe in fixing the year 1600 as not far from the proper date. 

*West. Ost., April, 1911. 



THE THERMOMETER 263 

One hundred years after this, physicists were earnestly working 
on the problem of a proper scale for the thermometer. About 1714, 
Daniel Gabriel Fahrenheit, another Hollander, produced a thermometer 
in which mercury took the place of alcohol, and, so far as we know, 
he was the first one to use zero on a thermometer scale. His zero 
point was fixed at what he regarded the lowest attainable tempera- 
ture. This was the temperature produced by mixing ammonium 
chloride and ice. He arbitrarily fixed the temperature of the human 
body at 100 degrees, and divided the space between his zero and the 
temperature of the body into one hundred equal parts. Two hundred 
and twelve of these parts is the temperature of boiling water, and 
thirty-two of these parts is the temperature at which water freezes. 
More careful observation of the Fahrenheit scale has shown that he 
was about one and one-half degrees wrong in regard to the tempera- 
ture of the body, and consequently his whole scale becomes purely 
arbitrary. 

In 1730 Reaumer gave his scale to the world. He fixed the freez- 
ing point of water at the zero point and its boiling point as one hun- 
dred degrees. For some reason, not now known, he afterward changed 
the boiling point of water to eighty degrees. 

In 1742 Andrew Celsius reintroduced the scale formerly proposed 
by Reaumer, with the exception that he reversed it, calling the freez- 
ing point of water one hundred and its boiling point zero. 

About twenty-five years after this, this scale was reversed by 
the Swedish botanist, Carl Linnaeus. It is this scale which is still 
used in the Centigrade thermometer. Centigrade thermometer, and 
the metric system of weights and measures are much more philosophi- 
cal than the Fahrenheit thermometer and the common English system 
of weights and measures, but such is the vein of conservatism run- 
ning through our natures that in spite of their utter lack of philosophy, 
both of these systems are still in use and will perhaps remain in use 
for some time to come. It is probably needless to call the attention 
of physicians to the fact that unless a scale of correction is furnished 
with a thermometer, every new one should be carefully compared with 
a standard thermometer. This is owing to the impossibility of making 
an instrument absolutely correct from a mechanical standpoint. 



264 ARTICLES OF GENERAL INTEREST 



*THE UNITED STATES PHARMACOPOEIA. 

There are comparatively few books which more intimately con- 
cern the medical profession than does the United States Pharmacopoeia, 
and yet comparatively few physicians seem to have other than the most 
shadowy and vague ideas about this work. 

The word "pharmacopoeia" is of Greek origin, and it means "to 
make medicine." The object of the work is to insure the standard- 
ization of preparations used in medicine. For instance, the liquid we 
buy under the name of spirits of camphor consists of camphor gum 
dissolved in alcohol; but as camphor gum is freely soluble in alcohol, 
one will readily see that, if the spirits of camphor is always to be of the 
same strength, a definite amount of the gum must be added to a definite 
amount of alcohol; and as alcohol somewhat diluted with water will 
also dissolve camphor gum, if the preparations are to be uniform, the 
alcohol used must always be of a given strength. It is to insure such 
uniformity as has been suggested that the Pharmacopoeia exists. 

The first American Pharmacopoeia was issued in 1820, and since 
then a new edition has appeared during each decade. The entire set 
of Pharmacopoeias furnish much food for thought to the student of 
the history of medicine. Each one as it has appeared has faithfully 
reflected the medicines which at that time were regarded as efficient 
for the treatment of disease. Very few medicines have stood the 
test of time. With each new edition of the work, some have been 
dropped and new ones have been added. The mere fact that a given 
preparation appears in a Pharmacopoeia is no reason for assuming 
that it has real therapeutic value. It merely means that a consider- 
able number of physicians have been in the habit of using it and 
perhaps believe that it is valuable; but that this belief is often tran- 
sient is shown by the facts which I have just cited. 

By way of illustration, let me say that witch hazel at the present 
time is highly valued by many physicians as well as by the laity. 
It is, however, about as inert as anything can be. Nevertheless, be- 
cause it is in demand, it has a place in the Pharmacopoeia. If any 
considerable number of physicians should come to believe that sea 
sand is valuable for the treatment of disease, it would at once be 
admitted to the Pharmacopoeia, and the standard of its purity and 
method of preparation would be established by that work. 

*West. 0st„ Feb., 1910. 



THE UNITED STATES PHARMACOPOEIA 265 

It is one of the peculiarities of Anglo-Saxon civilization to allow 
matters of great public importance to be undertaken by individuals. 
While the Pharmacopoeia has no legal standing, it is nevertheless 
the acknowledged standard used by the United States Government 
in determining cases relating to the pure food law. In somewhat 
the same way, a semi-religious organization known as the Brethern 
of the Trinity control the entire lighthouse system of England. 

In the early days of the Pharmacopoeia, the work was entirely 
done by physicians, but between 1850 and 1860 the science of phar- 
macy underwent rapid development, and since that time pharmacists 
have taken a more or less active part in the production of the Phar- 
mocopoeia, and at the present time physicians have little to say in 
regard to what shall or shall not appear on its pages. 

Those who use drugs in the treatment of disease are feeling 
more and more keenly the serious need of an international pharma- 
copoeia. For instance, arsenical preparations which are used in 
medicine vary from arsenic 1 in 10,000 to arsenic 2 in 100, in western 
European countries, so that the physician who should write a pre- 
scription containing arsenic as he would write it in his own country 
might easily prescribe a fatal dose to a patient living in another 
country. As Canadian standards are widely different from our stand- 
ards, it is easy to see that, owing to physicians freely crossing the 
line, serious mistakes might easily occur. 

While we are developing a drugless system of therapeutics, the 
fact still remains that there are lotions and preparations of many 
kinds which every physician must use, and the great source of infor- 
mation in regard to all of these is to be found in the American Phar- 
macopoeia, a new edition of which will very soon be placed upon the 
market. 



During the past month a considerable number of milk examina- 
tions have been made in the pathological laboratory of the college. 
In a surprising number of cases the nutrient content of the milk 
has been found surprisingly low and in every case where a better 
quality of milk has been furnished infants they have made the most 
striking improvement. It certainly appears that the physician is not 
justified in treating a babe that is not doing well without having a 
careful analysis made of the milk which the child is using. Frequent- 
ly the only attention which the child needs is an improvement in its 
diet. 



266 ARTICLES OF GENERAL INTEREST 



*MEDICINES AND THEIR EFFECTS. 

No intelligent person who has had very much experience with the 
sick will deny the fact that medicines sometimes appear to accomplish 
very desirable results. If this is so, why not use them? It is cer- 
tainly not enough to tell the intelligent practitioner of today that he 
must not use a given method of treatment with his patients because 
it is "not osteopathic." Common humanity would compel him to use 
things that are good even if his loyalty to a system of practice might 
otherwise have prevented his doing so. If the osteopathic physician 
of today is to condemn the use of medicine, his condemnation to have 
any weight either with his fellow practitioners or with the public must 
rest upon a scientific basis. A belief that such a basis exists, that it is 
genuine and that it is sustained by the results of the most rigid investi- 
gations is my personal reason for objecting to the use of drugs. 

A short journey into the field of general biology is required to 
show the validity of this position. All of the cells which enter into 
the structure of the more complex organisms can be divided into two 
groups : the first group comprising those which form the body of the 
individual ; the second group is made up of the reproductive cells. 

The reproductive cells differ from the cells composing the body in 
that under favorable conditions, they may unite with other repro- 
ductive cells and by so doing, acquire a capacity for reproduction which 
they did not previously possess. All cells at some period of their lives 
possess the power of reproduction but those cells which are incapable 
of conjugation (or uniting with other cells) possess only a limited 
power of reproduction ; for instance, the nerve cells found in the human 
brain have exhausted their power of reproduction long before the in- 
fant is born, and however long he may live, it appears to be impossible 
to increase the number of nerve cells. 

The connective tissue cells and the muscle cells possess a greater 
power of reproduction than do the nerve cells. Under ordinary condi- 
tions this reproductive power lasts long enough to supply the needs 
of the human being during an ordinary lifetime. The epithelial cells 
which cover the surface of the body possess such an enormous capacity 
for reproduction, that their power is seldom exhausted during life, 
though it is possible that some cases of senile gangrene may be due 

*Address, Round Table on Children's Diseases, Chicago meeting Am. Ost. Ass'n, 
1911. Pub. Jour. A. O. A., Sept., 1911. 



MEDICINES AND THEIR EFFECTS 267 

to the epithelial cells having exhausted their power of reproduction. 
The epithelial cells of the glands have far less reproductive power than 
have the epithelial cells found upon the surface of the body. Their 
reproductive power is sufficient for an ordinary lifetime only when ex- 
cessive demands are not made upon them. 

As an illustration, that seems fairly good for the cells of the body, 
I would suggest that one should think of an infant at whose birth some 
person should deposit $1,000 for each year that the child may live. 
We will assume that the child may live seventy-five years and that 
$75,000 is deposited with the understanding that $1,000 may be used 
each year for its support. If the child should assume charge of him- 
self, he might by experimentation find that a check for $2,000, $5,000 
or even $10,000 is honored quite as readily by the bank as a check for 
$1,000, nevertheless, we can readily see that if he draws any consider- 
able number of these large checks, the time will inevitably come when 
his money will be quite exhausted. So it appears to be with the epithe- 
lial cells of the glands of the body when their reproductive powers 
have been exhausted or destroyed by the use of drugs. 

Of these glands we have more practical knowledge of the kidneys 
and of the liver than any of the others. Careful investigations that have 
been made by competent pathologists, show that almost all drugs are 
destructive to the epithelial cells of the kidneys. Prof. Pearce, of the 
medical college of the New York university, states that this is true of 
salts of all metals. To this he adds coal tar products, alcohol, oxalates, 
essential oils, immune serum and a number of other substances, some 
of which are not commonly used by physicians. 

Now if this is true and it certainly appears to be, it means that the 
medicines which are given to the child and which may appear to have 
a reasonably good effect, really make an excessive demand upon the 
reproductive power of the kidney cells and if they are used to any 
great extent, the reproductive power of the kidney is exhausted com- 
paratively early in life and so the patient comes to be the victim of 
nephritis. This is in strict harmony with common observation. 

The physician who has a practice of any extent, cannot fail to 
note the large number of middle-aged people who come to him suffering 
from nephritis and in many cases the cause of the disease is not easy 
of explanation, but when we remember how universal drugging is and 
when we remember that salts of all metals, sodium chloride, (common 
salt) not excepted, are more or less destructive to the kidneys, causing 



268 ARTICLES OF GENERAL INTEREST 

the rapid destruction and multiplication of kidney epithelium, and 
when we remember that the number of times any given cell can divide 
is limited, it then becomes easy for us to understand why it is the kidney 
gives out long before the other parts of the body have lost their vigor. 



*ICHTHYOL. 

Ichthyol is the trade name of a dark brown antiseptic substance 
which is about as thick as tar. 

Ichthyol is obtained in the Austrian Tyrol by distilling an albu- 
minous shale in which there are large numbers of fossil fish and other 
forms of sea life. The name of the substance was undoubtedly sug- 
gested by the remains of the fish present in this shale, as the word 
Ichthyol really means "fish oil." The shale is heated in huge receivers 
tc a temperature of somewhat more than 200 degrees centigrade, and 
at this temperature the volatile oils are driven off and condensed. 
These oils are treated with sulphuric acid and the ichthyol of com- 
merce is the ammonium salt of this acid preparation. 

As before stated, ichthyol is a strong antiseptic and like most 
other antiseptics, it is a poison. It should not be used in full strength 
upon a mucous surface. It may be diluted with either water, alcohol 
or glycerine. A favorite preparation is made by adding one part of 
the ichthyol to from ten to eighteen parts of glycerine. Used in this 
strength it is still strongly antiseptic, but there is little danger of 
enough being absorbed from this preparation to injure the patient. 

Ichthyol is used by many physicians as a vaginal and uterine wash 
under the impression that it "heals." This is far from being the case. 
The only good which can come from it is from its antiseptic proper- 
ties, and if a raw or denuded surface is kept free from bacterial in- 
fection, nature will soon attend to the healing, and all that Ichthyol 
or any other preparation can do is to get the tissues in such condition 
that the healing forces of nature can act. 



*West. Ost., Nov., 1913. 



MEDICINES THAT ARE HARMLESS 269 



*MEDICINES THAT ARE "HARMLESS." 

In these days when large numbers of people are striving to live 
without being producers we need not be particularly surprised to find 
many who are striving to get a living by the sweat of other men's 
brows by manufacturing and selling what are commonly called "harm- 
less medicines." 

The osteopaths are at the present time being earnestly canvassed 
by agents for several of these so-called "harmless" preparations. So 
far as any special effect upon the human body is concerned, we sus- 
pect that many of these preparations are practically inert and when the 
agent tells us that they are harmless we presume that he tells the truth 
so far as their direct effect upon the body is concerned, but their harm- 
fulness is very direct, because they so often prevent the physician from 
doing the real thing which may be of service to his patient. While the 
physician is administering these entirely unknown and inert remedies, 
valuable time which ought to be devoted to doing something that would 
count is being lost. 

We certainly have no ill feeling toward the man who has given 
careful attention to drugs and drug medication who uses drugs in his 
system of therapeutics. We are very honest in believing that he is 
mistaken in regard to the best means of treating disease, but we are 
willing to believe that he is conscientious and that he is doing the best 
that he knows. We are wholly unable to take the same charitable view 
of drug-dabbling osteopaths. Our colleges are not teaching drug med- 
ication, and the osteopath who uses drugs does so fully conscious of 
the fact that he has had no training or preparation which warrants his 
using them or which will sufficiently guide him to prevent his doing 
his patient serious and possible irreparable injury. If drug medica- 
tion is the best treatment for sick people, our colleges are certainly on 
the wrong road. If, on the other hand, the therapeutics which they 
are teaching represent the best system, our people make a great mis- 
take in wasting their time and the time of their patients with drugs 
which are ignorantly administered. As far as our observation goes, 
we feel quite certain that the most successful osteopathic physicians are 
those who adhere most strictly to the system of non-drug therapy and 
we feel very certain that so far as they educate themselves sufficiently 
and so far as they let drugs alone, they will in every case be successful 
when brought into competition with the drug-giving doctors. 

*Ed., West. Ost., May, 1911. 



270 ARTICLES OF GENERAL INTEREST 



*ADDICTION TO DRUG HABITS. 

Dr. Lyman F. Kebler, chief of the drug division of the United 
States Department of Agriculture, has recently made some very inter- 
esting investigations in regard to the use of habit-forming drugs in 
the United States. 

By the term "habit-forming drugs" is meant opium, morphine and 
their derivatives, cocaine, codeine, acetanilide, antipyrine, chloral hy- 
drate and a few other drugs more or less related to these. Dr. Kebler 
points out that notwithstanding adverse legislation by states and cities, 
the use of these drugs is constantly on the increase. The use of opium 
and opium derivatives has more than doubled per capita during the last 
forty years, and this in spite of the fact that we have other drugs of 
similar properties and also extensive use. Cocaine has been in use 
about twenty-five years. Its use is now so enormously increased that 
about 150,000 ounces are required each year to supply the demand. Dr. 
Kebler states that this is at least ten times as much as is needed for 
the legitimate uses of this drug. Each year we import about 500,000 
pounds of opium. With the rise of cocaine the use of opium has some- 
what decreased of late, the importation last year being about 20,000 
pounds less than the previous year. 

In many foreign countries, such as Germany, Holland, Italy and 
Spain, the use of these drugs is strictly supervised by the government. 
Judged by the standard employed in those countries, between eighty 
and ninety per cent of the opium used in this country is improperly 
used. If the opium compounds were used by our people as they are 
used in foreign countries, 50,000 pounds would easily supply all of 
our needs. 

It is believed that between 1,000,000 and 4,000,000 of our people 
are more or less seriously addicted to drug habits. The evils of the 
drug habit make themselves manifest both in social and business life. 
In a country such as ours, laws are comparatively inefficient in coping 
with an evil such as this. It is a matter extremely creditable to all 
concerned that manufacturers, importers and wholesalers of drugs are 
united in recognizing the evil of traffic in these compounds and they 
are voluntarily exerting a strong influence against their use. 

Many of our soothing syrups and soda fountain drinks are more 
or less responsible for the formation of the drug habits. Then, too, 

*West. 0st„ March, 1911. 



ADDICTION TO DRUG HABITS 271 

there is the prescription of the careless and thoughtless physician that 
annually fastens the habit upon large numbers of people. Just what 
is to be done to diminish the use of these drugs is a question by no 
means easy of solution. In a broad and general way we may say that 
the use is to be combatted by right living. There is comparatively little 
pain that is not the result of wrong living, and certainly in large num- 
bers of cases pain was the primary cause for the formation of a drug 
habit. 

The contribution which the osteopathic physician is able to make 
to the diminution of the use of these drugs is to so familiarize himself 
with the principles of his own practice that he will be able to control 
most cases of pain without resorting to a stupefying drug. It is quite 
possible that circumstances may arise where the use of the drug 
seems to be the only resort, but among our more intelligent prac- 
titioners such cases are not common. There are, of course, many ad- 
vertised cures for the drug habit, but the value of most of these is 
extremely questionable. Certainly in many cases the cure is quite as 
bad as the disease. 

A potent factor in the prevention of the habit is education. This, 
in my judgment, is more important than stringent laws. No matter 
how carefully the law may be worded, the person craving for a drug 
will be likely to find some means of evading it, but if young people 
grow to maturity with a full knowledge of the dangers incurred by 
the use of soothing and quieting drugs, they will not be very likely to 
begin their use. Let us, as a profession, give this matter the careful 
and serious thought to which it is entitled because of its importance. 



There is a rapidly growing sentiment in all intelligent communities 
which favors the proper inspection and health examination of school 
children. This is necessary not only for the well-being of the child 
himself, but as a means of protecting other children from contagious 
diseases. It seems to us that all right-thinking people must feel that 
the inspector charged with these important duties is a most important 
public servant, and it appears to us that his first, and in fact his only 
qualification, should be fitness for this particular line of work. It is 
really a matter of little importance from what source his education 
was derived, providing he is educated to do this work as it should be 
done. 



272 ARTICLES OF GENERAL INTEREST 



*ABSINTHE. 

Absinthe is a narcotic liquor, which is made by distilling a certain 
species of wormwood with alcohol. The beverage resulting from this 
process possesses not only all the evil effects of alcohol, but also the 
still more evil effect of absinthe, which is extracted from the worm- 
wood. The particular species of wormwood from which absinthe is 
obtained grows in eastern France and Switzerland. Taken in very 
small quantities, absinthe acts as a nerve stimulant, producing a 
marked feeling of exhilaration, which is followed by a period of great 
depression. Taken in any quantity, it acts disastrously upon the men- 
tality of its victim — some of the results being hallucinations, both of 
vision and hearing. The delirium resulting from the excessive use of 
alcohol is very much milder than the delirium resulting from the use 
of absinthe. Not only is absinthe terribly disastrous to the nerve sys- 
tem of the individual, but it distinctly predisposes one who uses it to 
tuberculosis, pneumonia and the severer forms of epilepsy. Animals 
are affected by it in much the same way that people are. A dog which 
has been given a dose of absinthe will leap to its feet from its sleep 
and growl and bark and snap at empty space, evidently fancying in its 
delirium that it sees objects which are not present. 

Of all people, the French are suffering the most from the use of 
this terrible drug. Between the years of 1901 and 1904, the amount 
sold to the French people increased from seventy-four thousand gal- 
lons to ninety thousand gallons. Many European countries and some 
of the countries of the West are now taking serious steps toward con- 
trolling the use of this drug, which fills poor-houses, insane asylums 
and jails, and which makes the man who uses it an irresponsible brute. 
The first country to prohibit its importation and use was Belgium. The 
good example set by this country was followed in turn by Holland, 
Switzerland and Brazil. It is now excluded from the United States, 
and Germany is taking strong measures to prevent its sale. 

Its use is so widespread in France and there are so many money 
interests behind its sale, that the French have up to this time been 
unable to enact drastic laws controlling it. 

Every intelligent physician should be ready to use his utmost 
influence against this drug, and help to create a public sentiment which 
will forever keep our people from becoming its victims. 

*West. Ost., Nov., 1912. 



COPPER SULPHATE IN EPISTAXIS 273 



*COPPER SULPHATE IN EPISTAXIS. 

In your issue of January, I noticed a short article on Epistaxis 
copied from the New York Medical Journal. I believe that much of 
the treatment suggested in the brief article is reasonably good and safe, 
but I certainly think that a strong protest should be made to using a 
saturated solution of copper sulphate. It is almost needless to say 
that a solution of this kind will nearly or quite destroy the mucous 
membrane to which it is applied. In fact, its value is due to the fact 
that it is destructive to the mucous membrane and that it stimulates the 
growth of connective tissue, really forming scar tissue in the part re- 
ceiving the application. While this may stop the bleeding, it certainly 
paves the way for all kinds of future trouble. 

As Epistaxis may be due to a number of different causes, I would 
respectfully suggest that it would be quite the natural thing for the 
osteopathic physician to find the cause and then attempt to remove it. 



Some time we can say with Whittier: 
"What matter I or they? 
Mine or another's day, 
So the right word be said, 
And life the sweeter made?" 

But that time is not yet. We have not made our full contribution 
to the medical profession, and in order that we may make this contri- 
bution, we must maintain an absolutely separate school of practice. 
I cannot agree with my friends who believe that we can maintain this 
separate school of practice, or even help to maintain it, by what seems 
to me the childish expedient of using separate degrees alone, but we 
can maintain the separate school of practice by having a definite system 
founded upon research and intelligent experimentation. 



*Jour. A. O. A., March, 1910. 



274 ARTICLES OF GENERAL INTEREST 



*MENDEL'S LAW. 

It is now more than fifty years since an Austrian monk, John 
Mendel by name, made some most interesting discoveries in regard 
to the laws of inheritance, as the result of most patient work in the 
flower garden. Mendel's conclusions were presented to the world 
in a short but clearly written paper, but the scientific world had not 
yet ripened up to the point where his work seemed of any value and it 
appears that few people read the paper, and those who did read it 
straightway forgot what it contained. 

Ten years ago, a little more or less, Hugo De Vries, a Hol- 
lander, rediscovered many of the facts relating to inheritance which 
Mendel had discovered forty years previous. The world was now 
ready for this information and the work of De Vries met with a 
warm reception. Quite recently Mendel's original paper came to 
light, and it was found that the conclusions of the two naturalists 
were strikingly similar. These laws of inheritance apply to almost 
every departure of nature. Statistics gathered from European as 
well as from American asylums for the insane and feeble-minded 
show that "Mendel's law," as it is commonly called, applies even to 
these unfortunates. Of course it must not be understood that the law 
is as exact as mathematics, but where large numbers of cases are ex- 
amined, the deviation from Mendel's law is so slight that the deviation 
may be disregarded. The practical application of this law may be 
stated as follows: 

First — Insanity will be inherited by all of the children if both 
parents are insane. 

Second — Where one parent is insane and the other normal, but 
the normal one has one insane parent, one-half of the children will 
be insane and one-half will be normal, but all will be capable of trans- 
mitting insanity to their offspring. 

Third — If one parent is insane and the other is normal and of 
pure normal ancestry, all of the children will be normal, but they 
will be capable of transmitting the insanity to their descendants. 

Fourth — If both parents are normal but each has one insane 
parent, one-fourth of the children will be normal and will not trans- 
mit insanity to their offspring; one-fourth of the children will be 

*West. Ost., July, 1911. 



ARTIFICIAL FERTILIZATION OF EGGS 275 

insane; the remaining half of the children will be normal but may 
transmit the insane taint to the offspring. 

Fifth — If both parents are normal, one having a pure normal 
ancestry, the other an insane parent, all of the children will be normal 
and only one-half of them will transmit the taint to their progeny. 

Sixth — When both parents are normal and of pure normal an- 
cestry, all of the children will be normal and will not be capable of 
transmitting an insanity taint to their offspring. 

We believe our readers will be wise in keeping this in such a 
place that it may readily be referred to, as questions involving the 
principles of inheritance frequently arise. 



*ARTIFICIAL FERTILIZATION OF EGGS. 

It is now some years since Dr. Jacques Loeb demonstrated the fact 
that eggs can be induced to begin segmentation without fertilization. 
Dr. Loeb applied chemical methods to accomplish this result, and his 
experiments have gone far to modify many of our previous views in 
regard to the nature of fertilization. In most cases, the egg which is 
artificially started in its development does not progress very far until 
the embryo dies, but it has been recently found that if the egg of the 
starfish is chemically fertilized, and then kept in slightly concentrated 
sea water, it will progress far in its development. 

Dr. Robertson, of the University of California, has succeeded 
in extracting from the sperm cells of some of the lower forms of life, 
living substances which are capable of fertilizing the eggs of that species. 
It now seems that the substance capable of inducing fertilization may 
be extracted from the body cells as well as from sperm cells. It seems 
that this substance may be extracted from the blood cells of cattle ; 
possibly from other of the higher animals. The reason why this 
substance does not fertilize the ova of the female while the ova are yet 
within the body, appears to be that the ova are surrounded by an 
impenetrable membrane. Further experimentation along these lines 
may yet yield interesting results, and as we before hinted, many of our 
cherished ideas in regard to the nature of fertilization may have to be 
profoundly modified. 



*West. Ost., Nov., 1912. 



276 ARTICLES OF GENERAL INTEREST 



*THE ANCIENT CITY OF SANTA FE. 

Few people seem to have any accurate knowledge of this inter- 
esting and wonderful old city. It is very easy for any one traveling 
over the Santa Fe railroad to get to the city and no person possessed 
of proper intelligent curiosity fails to feel exceedingly well paid for the 
time spent in going there. 

Santa Fe is almost exactly eighteen miles north of Lamy, a small 
station in New Mexico on the Santa Fe road. Although the distance 
from Lamy to Santa Fe is so short, it requires almost one hour for a 
train to travel from one place to the other. This is due to the fact 
that Santa Fe is some five or six hundred feet higher than Lamy, so 
there is a stiff up-grade almost the entire distance. 

The present population of Santa Fe is not far from 10,000. The 
people are probably nearly evenly divided between those of straight 
American stock and those of Spanish and Indian descent. 

The streets of the older parts of the city are very narrow, many 
of them not being more than twenty feet in width. The most impor- 
tant place in the city is the old plaza. This is a park containing be- 
tween two and three acres of land. Trees were planted here a good 
many years ago and the place is delightfully shaded. Originally this 
plaza was entirely surrounded by buildings making it a court yard, 
but it is now only on one side that a remnant of these buildings is to be 
found. This building is known as the old palace and it extends the 
entire length of the park. 

Santa Fe was really an old city when the pilgrims landed on Ply- 
mouth Rock, and indeed it was an old city when first discovered by the 
Spaniards. Here was one of the important pueblos of a now forgotten 
race whose home extended from central Utah to far below the equator 
in South America. It seems quite certain that the race that built the 
great pueblos in Utah, in New Mexico, Arizona, throughout old Mex- 
ico, throughout Central America, down to the southern part of Peru, 
belonged to the same race and it is quite certain that these people were 
not closely related to the Indian savages with which the early European 
inhabitants of our country came in contact. On every hand in Santa Fe, 
one perceives evidences of the past. The old mission church in Santa 
Fe was first built on its present site sometime in the 16th century. It 

*So. Pas. Rec, Aug., 1911. 



ANCIENT CITY OF SANTA FE 277 

has been more or less completely destroyed two or three times, but it 
still stands on the old site and the timbers which one sees on the inside 
of the church were old before the Revolutionary war began. 

Close to the side of the church stands what is probably the oldest 
dwelling house in the United States. This old building was built upon 
the ruins of a dwelling house belonging to the prehistoric race of which 
I spoke. Until comparatively recent time it was two stories high, the 
upper story being now entirely gone but those who live in the single 
story are inhabiting rooms which could tell of perhaps more than a 
thousand years of human joy and sorrow. Look in what direction one 
will and he sees, standing side by side, buildings that are modern and 
symbolical of the life of today and the old adobe structures, symbolical 
of the past. 

Until the continent was crossed by railroads, Santa Fe was one of 
the important points of exchange between the great southwest and the 
east. The long road which led from St. Louis and Kansas City to 
Santa Fe was known as the old Santa Fe trail and from this city other 
roads led to the important points of the southwest. Immigrant trains 
from the city of Mexico were met in the Plaza by immigrant trains 
from cities in the Mississippi valley and here the trafficking took place. 

In this plaza in 1605 Onate raised the standards of Spain and pro- 
claimed this city the capital of the Spanish colonies in that region. It 
was in this same plaza in 1680 that the Indians driven to desperation by 
Spanish cruelty, murdered the Spanish inhabitants and burned what- 
ever they could of Spanish goods. In 1692, De Vargas re-established 
the power of Spain. In 1846, General Kearny, in this historical place, 
proclaimed the peaceful annexation of New Mexico to the United 
States. On a small monument commemorating this event is engraved 
the following: 

"On August 19, 1846, General Kearny said to the inhabitants then 
assembled in the plaza, 'We come as friends to make you a part of the 
republic of the United States. In our government, all men are equal; 
every man has a right to serve God according to his heart'." 

Here between 1840 and 1860, Kit Carson was a frequent visitor 
and here John C. Fremont, in the prime of his manhood and before he 
became the anti-slavery candidate for President of the United States, 
met other explorers, hunters and trappers and discussed the problems 
of the great Southwest. 

In the center of the plaza stands a monument dedicated to the 
soldiers of the various Indian wars as well as to those who were killed 



278 ARTICLES OF GENERAL INTEREST 

in the Civil War. This monument was erected by appropriations made 
by the legislature of New Mexico in 1866-67-68. The fact that on 
the part of the monument dedicated to the soldiers of the Civil War, the 
term "rebel" is used three times, shows the intensity of popular feeling 
in New Mexico at this time. It may not be out of place to record that 
their patriotism was not equaled by their etymology for on this monu- 
ment "February" is spelled "Febuary." 

There is a fine federal building in Santa Fe and in front of this 
building stands a modest but solid monument of Kit Carson. On sev- 
eral sides of this monument occur these inscriptions : 
"Kit Carson died May 23-1868, 
age 59 years." 
"Erected by comrades of the G. A. R." 
"Pioneer, pathfinder, soldier." 
"He led the way." 

Even a brief sketch of Santa Fe would be incomplete without men- 
tioning Fort Marcy. This historic old place ( for nothing remains there 
now but some mounds) stands on a considerable height above the city. 

Fort Marcy was the original site of the prehistoric dwelling. 
During Mexican days it was a military post. After the United States 
conquest of New Mexico, the old fort fell into ruins and as I have just 
said, nothing more remains of it than a few mounds and ditches. 

Near Fort Marcy is an old cemetery surrounded by an adobe wall 
some five or six feet in height. This wall incloses a plat of ground 
almost square and about one hundred and twenty-five feet on each side. 
In this old inclosure one finds the old and the new strangely blended. 
On a grave which was perhaps old when Continental soldiers were 
starving at Valley Forge, I saw a dilapidated bicycle that some one had 
thrown away. 

Near this cemetery are the ruins of an old church and a watch 
tower, the remains of which are still known by the old Spanish 
name of Garita. I could not suppress a smile when an old man who 
knew Santa Fe in the olden times, told me of the horrible cruelty of the 
Indians to the early settlers. He finished his story by telling me how he 
had seen numbers of the Indians brought in from the plains chained 
together like cattle and stood against the wall of the Garita and shot. 
As I listened to his narrative, it occurred to me that all of the cruelty 
and all the savagery was not confined to one side. 



AMERICAN SCHOOL OF ARCHEOLOGY 279 



AMERICAN SCHOOL OF ARCHEOLOGY. 

Santa Fe, New Mexico, is the seat of the School of American 
Archaeology. The Archaeology Institute of America established this 
school in 1907 and it is under the immediate direction of Prof. Edgar 
L. Hewett. The headquarters of the school of archaeology is in the 
old palace in Santa Fe. This building extends the entire length of the 
north side of the historic plaza of the city. It is one story high and 
two rooms in depth. 

The wall running lengthwise of the building is of prehistoric origin 
and was so honestly constructed that all of the builders, beginning with 
the Spanish times, have utilized this wall. In a lecture which I heard 
Prof. Hewett deliver, he clearly explained how to distinguish between 
the walls belonging to the prehistoric races and the walls built under 
the inspiration of the Spaniards. 

When the latter began to influence the construction of buildings 
they introduced the adobe brick and walls were built of this material. 
The prehistoric races simply puddled their clay and built an absolutely 
solid wall. In other words, the prehistoric walls were built in the same 
way in which we are building cement walls today. 

The palace has been given to the school of archaeology and is used 
by it not only for lecture room purposes but also as a museum and 
in this building, which is itself a specimen of the utmost archaeological 
value, will be collected relics both of the prehistoric peoples of the 
southwest and of the present savage inhabitants. 

The school of archaeology is not only investigating the various 
ruins found throughout our own southwest and extending into Mexico 
and Yucatan, but it is studying the social life, manners, customs and 
folklore of the Indians, who are still living, and not only this, but they 
are making a phonographic collection of the songs and speeches of a 
people who are likely to be exterminated at no distant date. 

It seems especially appropriate for a school of this kind to be 
established in Santa Fe. For this city is preeminently the capital of 
archaeological America. One can hardly help inquiring what will be 
the effect of this special line of education. It is impossible to listen to 
the interesting and thoughtful lectures of Prof. Hewett, Prof. Thomp- 
son and probably others connected with the school without feeling that 
the tendency is to teach us that all men are brothers, and that these 

*So. Pas. Rec, Aug., 1911. 



280 ARTICLES OF GENERAL INTEREST 

ancient races had their hopes and fears, their joys and sorrows, their 
loves and hates very much as we today have similar passions and feel- 
ings. From a philosophical standpoint, we learn that there is a gradual 
weeding out of the unworthy in the human race ; that both individuals 
and races, which are under the domain of the baser passions, lack the 
stamina and vigor of those who are better balanced and that in the 
mighty struggle for existence, the unfit are gradually crowded out. 

Not only is this southwest region interesting to the archaeologist, 
but it is interesting to the geologist and the paleontologist. Long before 
man in any form inhabited this region, it was thickly populated by 
gigantic animals that are now entirely extinct. One cannot visit the 
great museums and see these curious animal forms and the weapons 
with which savage men fought the most recent of these without feel- 
ing that : 

"A sacred kinship I would not forego 
Binds me to all that breathes ; 
I am the child of earth and air and sea. 
My lullaby by hoarse silurian storms 
Was chanted. Through endless changing forms 
Of plant and bird and beast unceasingly 
The toiling ages wrought to fashion me. 

Lo! these large ancestors have left a trace 

Of their strong souls in mine ; 

To grow and blossom as the tree, 

And ever feel deep-delving earthly roots 

Binding me closer to the common clay, 

Yet with its airy impulse upward shoots 

My soul into the realms of light and day." 

The directors and students of the American School of Archaeology 
are going to spend the latter part of the summer among the ruins of 
New Mexico and Arizona. They expect to accomplish the excavation 
of several ruined pueblos and it is highly probable that they will vastly 
increase our knowledge of a race that perhaps made the desert bloom 
with roses even as we are trying to do today. 

Interesting reports and bulletins are issued from time to time by 
the school. Anyone who is interested in this work can keep in close 
touch with it through these publications. 



OSTEOPATHIC PHYSICIANS 281 



OSTEOPATHIC PHYSICIANS 



Osteopathic practice, though young in years, has already a suffici- 
ent number of practitioners in the field to make some internal fermen- 
tation almost inevitable. In our branch of the medical profession, as 
in other branches, there is a considerable number of mere drifters, 
men and women whose chief idea is to use their profession as a means 
of making a more or less precarious livelihood. Such go on from 
day to day with little thought of the real significance of their work 
and without any definite aim or positive convictions. There is another 
class of most earnest and conscientious practitioners who are intensely 
loyal to osteopathic practice, as it was understood years ago and as it 
is still understood by a considerable number of osteopaths. These 
people are practically lesion specialists. Their training, education and 
habits of thought fit them to deal with certain classes of diseases and 
to secure results gratifying to both patient and themselves, but they are 
not physicians in the broad sense of the term. 

A very successful member of this class in the profession recently 
said: "It is with pleasure I feel that my success during the twelve 
years in the profession has, in a very great measure, been due to my 
effort to stick closely to 'simon pure osteopathic principles' in all my 
practice, and to accept only such cases as I thought could be cured by 
these methods." An announcement of this kind is, of course, a public 
proclamation that this doctor considers himself a specialist, and not 
an all-around physician. 

The third branch of the profession as we have it today consists 
of those who wish to practice as general physicians — men and women 
w T ho hold themselves ready to take any kind of a case which may come 
to them. It consists of those whose osteopathic ideals are expressed 
in the statement : "The true osteopath is the true physician. He must 
be fitted to do the best thing possible under every conceivable circum- 
stance of human suffering." 

While no one would have the slightest justification for con- 
demning the specialist, the fact still remains that the number who 
accept the ideal just stated is continually increasing, and it is the ideal 
which we must hold if we are going to develop our profession as it 
can be developed. 

Whether pleasing or displeasing to us individually; whether in 



282 ARTICLES OF GENERAL INTEREST 

harmony with our personal interests or quite the reverse, the fact 
still remains that the present division of medical practice into various 
"schools" is a condition which will not long continue. It is simply 
a matter of time, and I believe of a rather short time, when we shall 
know so much about the human body in health and disease that the 
line of demarcation between the different systems of practice will fade 
away. Believing as I do that drugs are injurious and are not curative 
in their effects, I cannot think they will have any important place in 
the medical practice of the future, but it seems to me that hygiene, 
public and private, hydro-therapy, possibly electricity will, together 
with mechanical adjustment, be the means employed by the physician 
of the future in caring for the sick. Such of these methods as are 
proved to be reliable will be the common property of all physicians. 
Our colleges will then seek to educate men and women most thoroughly 
in the deep knowledge of the human body, and the students thus 
educated will all have equal rights, equal duties, equal privileges ; and, 
since there will be no essential difference in their training and educa- 
tion, they will not be differentiated by different titles or degrees. The 
osteopath will be merged into the osteopathic physician, and he will 
use, as has already been suggested, those things which experience dem- 
onstrates to be the best in caring for the sick. Physicians thus edu- 
cated in other than osteopathic colleges will perhaps employ slightly 
different methods, but gradually all must fuse into one common in- 
distinguishable mass of doctors. 

I believe this is not a gloomy outlook for our profession. 

In one way, it is true, we shall lose our identity, but on the other 
hand we will have made our contribution to the universal whole. In 
other words, it will be in the medical profession as it is in our Ameri- 
can citizenship. England, Germany, Austria, and other European 
countries send us their emigrants, but in two or three generations we 
have no longer Englishmen, Germans, and Austrians, but we have a 
grander product, and that is the American citizen. We shall still have 
our colleges, but we will educate physicians. Our concern at the pres- 
ent time is to send the best educated products into the field which it is 
possible for us to furnish. 



WOMAN'S SUFFRAGE 283 



-WOMAN'S SUFFRAGE. 



It is only recently that I have realized that there is any "question" 
of woman's suffrage in the minds of intelligent men. It still seems to 
me absurdly incredible that in this land of boasted freedom, and in 
this age of the world's history, one-half of our people should seriously 
consider the possibility of denying privileges to the other half which 
that half may desire to possess. 

To say that it would be infamously wrong to deny suffrage to 
women is putting it much milder than I feel like putting it. I have 
heard a number of arguments advanced as to why suffrage should be 
extended to women and all of these arguments have appealed to me 
as extremely valid, but there is one which I have not yet heard which 
seems to me to be of special importance, and that is the fact that the 
world is built in such a way that it is impossible to do wrong to anyone 
without the wrong-doing inflicting its greatest injury upon the evil- 
doer. We have, of course, heard of the heavens prepared for those 
who do right, and the hells prepared for those who do wrong, but 
many of us have suspected that much of the conduct which it is popu- 
larly supposed merits either place is conduct founded upon artificial 
and false standards ; and feeling this to be true, we have in many cases 
grown away from the thought that punishment invariably follows 
wrong. In growing out of the thought that we are punished for our 
sins we have failed to recognize the great truth that we are indeed 
punished by them. We have expended our sympathy upon the 
wretched criminal who is murdered by a frenzied mob, forgetting that 
the death of the criminal is of little importance when compared with 
the evil which the mob inflicts upon its own members, by making them 
criminals. We have had stilted and absurd interpretations placed upon 
the declaration of a great teacher who said in substance. "Inasmuch, 
as ye have done either good or evil unto the least, ye have done it unto 
me," meaning ye have done it in spirit unto the greatest. 

This statement embodies a profound truth. Wrong that is in- 
flicted upon one member of the community because he is helpless is in- 
flicted upon other members when they become helpless. Lowell saw 
this when he wrote: "Them that make black slaves of niggers, want 
to make white slaves of you." 

Men who are willing to tyrannize over women because they hap- 

*So. Pas. Rec, Apr., 1911. 



284 ARTICLES OF GENERAL INTEREST 

pen to have an opportunity of doing so are men who tyrannize over 
their fellow men when the opportunity offers itself. It is a dangerous 
thing to get the spirit of tyranny and intolerance started in any com- 
munity. One never knows where the lightning will strike. 

I feel that every man who casts a vote next fall against woman's 
suffrage is a tyrant at heart and that the only reason why he does not 
tyrannize over me is because he can't, but at the first opportunity I 
may be the victim of his tyranny, and if for no other reason than with 
the thought of protecting myself against the tyranny of my fellows I 
shall vote for woman's suffrage. 



-THE COST OF LIVING. 



The high cost of living is a subject which is receiving almost 
universal consideration, and many are the causes which are suggested. 
Some of the causes suggested seem rather fanciful, — others are prob- 
ably real factors in the case. We may feel quite sure that the advance 
in the cost of living is not due to any one thing, but is due to a com- 
bination of conditions. 

There is one means which we of South Pasadena have of reduc- 
ing our cost of living. It has been tried in many other cities with 
success. The means to which we refer is to utilize the vacant land in 
our city, — to use it, not for growing weeds, but for growing vegetables 
which may be used as food. There are numerous boys growing up 
in our city who are laying no proper foundation for future usefulness ; 
not because they are intrinsically bad, but because they have no definite 
employment. There are a great many acres of absolutely idle land in 
our city. We could not add to the physical health of the rising gener- 
ation or to their moral stamina more than by engaging some competent 
gardener who would work with them and show them the dignity and 
worth of labor. This could be made financially profitable to the boys 
doing the work, and the right kind of supervisor, either man or woman, 
would teach them lessons which would be quite as valuable as any that 
they would learn in school or church. 



*So. Pas. Rec, June, 1913. 



THE OAK TREE 285 



*THE OAK TREE. 

The oak tree belongs to an old and highly respectable family of 
plants. Of its ancestry we know little, but it is certain that soon after 
the age in which the greatest deposits of coal were made, trees not very 
unlike our modern family of oaks existed. It need be no matter of 
surprise to us that a family of plants so old as the Cupaliferse (or oak 
family) should have become widely disseminated over the earth. At 
the present time we find trees and shrubs belonging to the genus 
Quercus (the oaks) growing in Japan, thence westerly over Asia, climb- 
ing high in the Himalaya Mountains, then broadly scattered over Europe 
from the oaks of England famous in story and song, to the oaks of 
Italy famed for their beauty. We also find them in Northern Africa, 
and when we cross the ocean they spread from the dreary frozen 
wastes of Northern British America to the tropical lands through 
which we have recently cut the Panama Canal. 

Closely related to the oaks are the chestnuts, the beech, the filbert, 
the hazel nut, the ironwood and a number of other trees which grow 
only in tropical lands. In the far North and on the high mountains, 
the oaks grow only as very small trees or as bushes, while in more 
temperate lands and on the rich river bottoms the oaks grow into the 
true giants of the forest. Few trees produce wood which is of more 
commercial importance than the oak. It is almost unsurpassed in 
value as fuel, and oak lumber from the earliest ages has been re- 
garded as appropriate for the greatest and most magnificent edifices. 
In Westminster Abbey, oak beams brought from Ireland in the days 
of William the Conqueror are as solid now as when they were first 
fitted in their places; and in the days of wooden ships, those built of 
oak were regarded as the staunchest and best. 

In Northern latitudes the oak is deciduous. Its leaves die in the 
early fall, almost always assuming the most gorgeous colors and thus 
rivalling in beauty the maple tree. The dead leaves not infrequently 
hang on the tree during the greater part of the winter, and indeed some- 
times they are pushed off from their stools by the swelling buds of 
the new leaves. In Southern climates the oak is an evergreen tree 
and this branch of the oak family is often spoken of as the live oaks. 
It is difficult for one to realize the beauty of these magnificent trees 
until he has seen them and studied them, not only with the eye of the 

*P. 0. O. ''Reflexes." 



286 ARTICLES OF GENERAL INTEREST 

botanist, but also with the eye of an artist. In the city of New Orleans 
there is a park in which live oak trees" of gigantic size abound. In 
some cases the limbs extend a horizontal distance of seventy feet or 
more from the trunk of the tree. Some trees almost as fine may be 
found in the open canyons of the mountains of Southern California. 

It may not be without interest to recall the fact that the old ship 
Constitution, which won such just renown during the war of 1812 and 
which inspired Oliver Wendell Holmes' poem, "Old Ironsides," was 
built of live oak, most of which was brought from Florida and all of it 
from the South. Perhaps I should add that her masts were made 
from good New England pine. 

Here in California we have at least eight species of live oak trees, 
while about forty other species are found east of the Rocky Moun- 
tains. Some of our California species have a very restricted range 
and others, though widely distributed, are few in number. There is 
one specie which ranges from Altadena to Azusa. Between these 
places there are considerable numbers of these trees. One lone tree, 
however, is found near Santa Monica. Perhaps this lone tree tells of 
an acorn carried in the beak of some bird and which was dropped to 
the ground and lost rather than eaten. As before stated, the oaks 
which grow high on our mountains are little more than shrubs, many 
of them being only three or four feet in height, while on the low 
lands and broad river valleys they grow into veritable giants. 

No one can familiarize himself with this wonderful family of 
plants without being impressed by the profound way in which these 
trees are influenced by their environment, and how in every case the 
forms which the trees assume are those which best fit them to live 
under the conditions imposed upon them. 






SHORT BIOGRAPHIES 

The following short biographies appeared in the Western Osteopath, during 

191 1-1914. They were published as editorials, 

for the most part. 

HIPPOCRATES. 

The origin of medical practice is lost in the fog of myths and 
fables. The Grecians, five hundred years before Christ, believed that 
the first physician was a demigod named Aesculapius, the son of Apollo. 
At this time, temples dedicated to Aesculapius were to be found in all 
the more important Grecian cities. It is highly possible that these so- 
called temples partook quite as much of the nature of hospitals as of 
places devoted to worship. The current mythology of that time 
accredited Aesculapius with having had a daughter whose name was 
Hygeia. This daughter was the goddess of health, and our modern 
word "hygiene" was derived from her name. As in many other myths, 
the serpent plays a somewhat important part, and Hygeia was repre- 
sented by ancient artists as entwined by a snake, which was feeding 
from a cup held in her hand. It is quite possible that the connection 
between Hygeia and the snake was based upon a belief, which was 
common in Greece, that the snake renewed its youth by shedding its 
skin. 

Hippocrates was born about four hundred years before the be- 
ginning of our era into this world of myths and fables. He is often 
spoken of as the "Father of Medicine," though when we read the sane- 
ness of his views, we cannot help feeling that his thought had been 
stimulated and directed by thinkers who lived so long before his time 
that their names are absolutely forgotten. For hundreds of years after 
his time he was alluded to in Greek literature as "The Divine Old Man." 

When Hippocrates was born in Greece, disease was commonly 
attributed to the wrath of some offended god and attention was di- 
rected to fantastic methods of propitiating the god rather than to the 
public and private attention to cleanliness and care for sunlight and 
fresh air, which were then, as they are now, the most important agents 
in securing health. It seems that the energy of Hippocrates was 
specially directed against the supernatural cause of the origin of dis- 
ease. The account which Hippocrates gave of the appearance of the 



288 SHORT BIOGRAPHIES 

face of the dying is retained in our modern medical treatises with little 
modification. While many of the views of Hippocrates will not stand 
in the light of modern investigation, they were, at the time they were 
announced, founded upon the best scientific thought of the age. In 
his discussion of inflammation, a condition which he clearly recognized, 
he explained it as resulting from the passage of blood into parts not 
previously containing it. With slight modification, his views of this 
subject fit our modern pathology. 

Dr. Draper, in speaking of Hippocrates, says: "It appears that 
the practice of medicine in the hands of Hippocrates had reference to 
the course or career of disease rather than to its special nature." 
Nothing more than this masterly conception is wanted to impress us 
with his surprising scientific power. Not only did the life and work 
of Hippocrates serve to place the practice of the healing art upon a 
broad and scientific basis, but his life and his writings combined to 
impress physicians of all ages with the great moral responsibility 
which rests upon them. The Hippocratic oath, which until compara- 
tively recently was taken by all physicians, is probably little modified 
from the oath which he demanded of his disciples. As this oath is 
more commonly referred to than quoted, we venture to present it in 
its entirety. 

OATH OF HIPPOCRATES. 

"I swear by Apollo, the physician, by Aesculapius, by Hygeia, by 
Panacea, and by all the gods and goddesses, calling them to witness 
that, according to my ability and judgment, I will in every particular 
keep this, my oath and covenant: To regard him who teaches this 
art equally with my parents ; to share my substance, and, if he be in 
need, to relieve his necessities ; to regard his offspring equally with my 
brethren; and to teach his art, if they shall wish to learn it, without 
fee or stipulation; to impart a knowledge by precept, by lecture and 
by every other mode of instruction, to my sons, to the sons of my 
teacher, and to pupils who are bound by stipulation and oath, accord- 
ing to the law of medicine, but to no other. 

"I will use that regimen which, according to my ability and judg- 
ment, shall be for the welfare of the sick, and I will refrain from that 
which shall be baneful and injurious. If any shall ask of me a drug 
to produce death, I will not give it, nor will I suggest such counsel. In 
like manner, I will not give to a woman a destructive pessary. 

"With purity and holiness will I watch closely my life and my 
art. I will not cut a person who is suffering from a stone, but will 



GALEN 289 

give way to those who are practitioners in this work. Into whatever 
houses I shall enter, I will go to aid the sick, abstaining from every 
voluntary act of injustice and corruption, and from lasciviousness 
with women or men — free or slaves. 

"Whatever in the life of men I shall see or hear, in my practice 
or without my practice, which should not be made public, this will I 
hold in silence, believing that such things should not be spoken. 

"While I keep this, my oath, inviolate and unbroken, may it be 
granted to me to enjoy life and my art, forever honored by all men; 
but should I by transgression violate it, be mine the reverse." 

Surely, no one can read this and appreciate its significance without 
having a deeper regard for the moral side of his profession than be- 
fore, and no one can think of its Grecian author without a profound 
feeling of veneration and respect. No one can read very much of the 
writings of Hippocrates without being impressed by the fact that he 
placed great stress upon ascertaining the cause of disease and then 
undertaking to remove that cause by what he considered rational 
methods. As this is the fundamental principle of osteopathy, we are 
safe in looking upon this great Greek as one of the forerunners of 
what we today consider rationalism in medical practice. 



GALEN. 

During the early centuries of the present era our civilization had 
its center in and around Athens. Western Asia Minor had been colo- 
nized at an early time by the Greeks. The city of Alexandria in Egypt 
had been founded about 300 B. C. by the Greeks and the civilization of 
this city and of Western Asia Minor was of purely European or Greek 
origin. 

It was into this Grecian world that Galen was born about the year 
130 A. D. He was born in the city of Pergamus in Mysia, in Western 
Asia Minor. Early writers often speak of him as Galenus Claudius, 
and Chaucer in his Canterbury Tales calls him Gallien. It is said that 
he began the study of medicine at the early age of sixteen. It is quite 
certain that during his life he lived a part of the time in the city of 
Smyrna in Asia Minor, then in Egypt, Alexandria and a part of the 
time in the city of Rome. He died about the year 200 A. D., but the 
place of his death is uncertain. 



290 SHORT BIOGRAPHIES 

There are eighty-three treatises on medicine and medical subjects 
from his pen which are acknowledged to be genuine ; aside from these 
there are nineteen treatises ascribed to him, but the authorship is some- 
what doubtful. He was not only a busy physician, but an industrious 
writer, for it is believed that during his life he produced not less than 
five hundred distinct articles on professional subjects. His writings 
are known to have covered the subjects of anatomy, physiology, diet, 
hygiene, pathology, diagnosis, surgery, materia medica and perhaps 
some other subjects relating to the human body, either in health or 
disease. His knowledge of anatomy was derived very largely from 
animal dissection. He was one of the earliest writers to give special 
attention to the pulse and many of his views in regard to the pulse 
are strikingly in harmony with the views of today. It is in his writ- 
ings that we find the first mention made of "critical days" in disease. 
He was strongly of the opinion that if a patient passed what he called 
his "critical day," he was not likely to die until the arrival of the next 
critical day. His critical periods were seven days apart. As we read 
his materia medica we are impressed with the fact that many of his 
remedies and some which he considered the most valuable, are now 
known to be absolutely inert. In one of his treatises is found the 
assertion, "Disease is something contrary to nature and is to be over- 
come by something contrary to the disease." Another rather striking 
sentence is, "Nature is to be preserved by that which has relation to 
nature." (Possibly this was a hit at the modern vibrator.) 

There were medical sects in the days of Galen as well as at the 
present time. It appears that he gave a great deal of time and labor 
to an attempt to unite these various sects into one great school of the 
healing art, but it seems that the task was almost as difficult two 
thousand years ago as it is at the present day. No man is ever so strong 
intellectually as to ever completely rise above the views which are held 
by the masses of people of this time. Galen was no exception to this 
rule, for while many of his views are singularly strong and sane, his 
greatest admirers must still admit that he fell into many crude and 
childish delusions. One evidence of his strength is found in his in- 
sistence that experience is the only source of knowledge. He placed 
great value on the study of logic and mathematics and he believed that 
no system of theology would stand the test of critical investigation 
unless it were founded upon a profound knowledge of nature. 

The best work which Galen did during his lifetime was done in 
the city of Alexandria, which was perhaps to be regarded as the intel- 



ARISTOTLE 291 

lectual center of the world. The Alexandrian physicians who were 
most profoundly influenced by the work of Galen became divided into 
two groups ; one group was known as the Dogmatists. They asserted 
that the only rational foundation for the practice of medicine was a 
knowledge of anatomy, physiology, pathology, etc. Opposed to these 
were the Empiricists, who asserted that experience in dealing with 
the sick was the only foundation for medical practice. 

Perhaps we are justified in feeling that osteopathic physicians 
have seized upon and combined both of these schools of thought. We 
cannot read of the work of these great physicians and teachers of the 
past without feeling that we are the heirs of all the ages and that they 
were unconsciously laying the foundation for the work which has 
blossomed in our own age. 



ARISTOTLE. 

Aristotle was born in northern Greece in the year 384 B. C. ; he 
died 322 B. C. He came from a long line of physicians. His father, 
Nicomachus, was at the time of Aristotle's birth, physician-in-chief 
to Amyntias II., king of a province in northern Greece. 

His early training, so far as we know, came from his father, but 
when he was seventeen years of age he went to Athens where for 
twenty years he was in immediate contact with the great mind of Plato. 

When he was a little more than forty years of age, Phillip, King 
of Macedonia, appointed him tutor to his son, Alexander, who was 
afterward known as "the Great." In this way an intimate friendship 
was established between the great philosopher and the great conqueror. 

Alexander became king of Macedonia six years after his acquaint- 
ance with Aristotle began, and he soon set out on that marvelous 
career of conquest which revolutionized the governments of the ancient 
world. In his career as a military leader, Alexander pushed into the 
Far East, even into India. Aristotle accompanied Alexander on this 
expedition, and as Alexander was at the head of a great military expe- 
dition so Aristotle was at the head of a great body of scientific men. 
It is probably quite safe to say that the army of scientists accom- 
plished work which was of much more far-reaching importance than 
was that accomplished by the soldiers. It was at this time that many 
foreign animals and large numbers of plants were introduced into 



292 SHORT BIOGRAPHIES 

Europe and the intellectual supremacy of Greece was established, 
partly, at any rate, upon the results of this expedition. 

Aristotle's writings were not confined to medical subjects, as will 
be seen from the titles of some of his works : "On the Immortality of 
the Soul/' "On Justice," "On Philosophy," "On the Good," "Logic," 
"Ethics" and "Natural History." 

On his return from the extended expedition he supported himself 
as a physician and druggist in Athens. Up to the time of Aristotle 
most of the great minds of the world seemed to have reasoned by 
what is known as the deductive method, that is, they assumed certain 
things to be true and then inquired as to why and how they were true. 
On this basis all of the stories of the origin of the earth have been 
founded. Aristotle introduced what is known as the inductive method 
of reasoning. This method consists in first acquiring a knowledge of 
simple phenomena and from this knowledge proceeding to the more 
complex phenomena. 

It is said that Aristotle had both an esoteric and an exoteric phil- 
osophy. By the former is meant the profoundest truth with which one 
is acquainted, and many ancient teachers believed that this should be 
communicated only to the choice few; while the exoteric teachings 
were the doctrine which, it was supposed, was good for the masses of 
the people. It is, of course, needless to say that all true thinkers have 
long since outgrown the thought of any justification of two systems. 
We have come to believe that the simple truth is plain enough for the 
most humble and that it is majestic enough for the most elevated. 

The works of Aristotle were translated into the Arabic language 
during the eleventh century and almost all of our knowledge of him 
and of his teachings is derived from these Arabic translations. 

Aristotle appears to have been an untiring student, and while 
he held many views which the progress of knowledge has profoundly 
modified, he at the same time must be credited with having laid the 
foundation stone of modern biology. He may have believed in spon-' 
taneous generation, but we can forgive that when we remember that 
he described with accuracy the structure of the heart. 

The influence which Aristotle has exerted over human thought 
is probably greater than that of any other one man. For two thou- 
sand years his dictum was accepted as unquestionable truth. Men 
disbelieved the evidence of their own senses if this evidence was con- 
trary to the statements of Aristotle. And yet, such is the nature of the 
human mind, he was without special honor in his own country and 



AVERROES 293 

time. To those who knew him as a druggist in Athens he was "the 
vain and chattering little Aristotle." 

This only tends to illustrate the pathetic fact that every one who 
rises above mediocrity lives in solitude, largely unknown and un- 
appreciated by those most closely in contact with him. The higher 
qualities of the human mind are so comparatively recent in develop- 
ment that we have not learned to recognize those which differ ap- 
preciably from the qualities which we ourselves possess. The more 
primitive mental qualities have been so long possessed that they have 
become substantially the same in each person, and so it is quite easy 
with us to sympathize in the common every-day joys and sorrows of 
our fellows, but when it comes to the higher intellectual faculties, those 
things which make us most truly human, it is impossible for any one 
to comprehend with any clearness the feelings of another. This ac- 
counts for the remark which is so often made that the truly great 
person seems common when we are brought into contact with him. 



AVERROES. 

When Dante, guided by Virgil, made his somewhat remarkable 
trip through the Infernal Regions he came upon a place called Limbo. 
The people confined in this not particularly unpleasant place were 
those who had the misfortune to escape baptism. In the fourth canto 
Virgil says: 

"Then when a little more I raised my brow 

I spied the master (Aristotle) of the sapient throng 

Seated amid the philosophic train. 

Him all admire, all pay him rev'rence due." 

He says that he also saw: 

"Euclid and Ptolemy, Hippocrates, 
Galenus, Arian, and him who made 
That commentary vast, Averroes." 

The "commentary vast" to which he refers was Averroes' trans- 
lation and comments on the works of Aristotle. This great work 
was issued in ten large volumes. 



294 SHORT BIOGRAPHIES 

Averroes was of Arabian descent and he was born in the city of 
Cordova, Spain, some time between the year 1126 and 1198 and he died 
some time between 1198 and 1295. It will be remembered that some 
three hundred years before this time the Arabians had conquered Spain 
and had established a great Mohammedan civilization in that penin- 
sula. At the time Averroes was born Europe was largely sunk in bar- 
barism. Even the houses of the great still had floors of straw, and 
dignitaries of Church and State passed their lives with scant attention 
to the bath. European kings were for the most part unable either to 
read or to write, but in Spain a mighty civilization existed and the 
works of Aristotle and other Greek philosophers were eagerly read and 
studied, both in translation and in the original. 

Averroes' early training was entirely along the medical line, but 
such was his character for uprightness that in middle life he was called 
to assist as a counselor of state. This high position given to a physician 
not unnaturally resulted in jealousy and enmity and Averroes was at 
least temporarily brought into disgrace. He was charged with culti- 
vating and encouraging science to the detriment of religious faith, and 
for this he was cast into prison and subjected to most grievous humi- 
liation. 

After a few years spent in obscurity and in the practice of his 
profession, he was again called to public position, and there is reason 
to believe that in the evening of his days he enjoyed the confidence 
and respect of his countrymen. 

As a physician, Averroes held singularly rational views in regard 
to the cause and treatment of disease. He held drugs in light repute 
and placed more emphasis upon right living. His translation of 
Aristotle was carried across the mountains into Europe and went far 
toward introducing rationalism into the medical practice of Europe. 
The more one reads of these early physicians, the more he is impressed 
with the fact that the rampant drug medication of today is compara- 
tively new, and that the physicians of the middle ages held much more 
rational views than those with which they are usually credited. The 
statement which we have before made, that the osteopaths are the lineal 
descendants of the intelligent medical practitioners of medieval and 
modern Europe, certainly seems to be borne out by a close analysis of 
the facts. 

During the middle ages the Arabs and the Jews made wonderful 
contributions to medical science, and it is deeply interesting to note 
how nearly in harmony many of the views which they expressed are 



MARCELLUS MALPIGHI 295 

with the views held by the osteopaths of today. Let us sincerely hope 
that Averroes, from his place in Limbo, may occasionally glance upon 
us and may feel that we are carrying on a work, some of the foundation 
stones of which were laid by him. 



MARCELLUS MALPIGHI. 



The seventeenth century was a fruitful one for science. The mind 
of man seemed to be awakening from its long sleep and from the 
peculiar theological hypnosis which characterized the middle ages. 
Until the eighteenth century was well advanced, little encouragement 
was offered to progress. Indeed, it is safe to say that the self-interest 
of the thinker demanded that he suppress his thought and that he yield 
simple and childlike obedience to the beliefs which were popular at 
that time. It is for tnis reason that the few individual thinkers of that 
age stand out with peculiar prominence. 

Italy was in some respects the center of activity for this intellec- 
tual awakening. It was into a world of this kind that Marcellus 
Malpighi was born in the year 1628. His birthplace was the city of 
Bologna. Malpighi is described by his contemporaries as being a man 
of singular modesty, one given to quiet study and one who was of a 
singularly pacific and kindly disposition. Malpighi graduated as a 
physician from the University of Bologna in 1653. He immediately 
announced his intention of devoting his life to teaching and investi- 
gating, and in 1856, three years after his graduation, he was given 
the professorship of anatomy in his alma mater. 

He remained in Bologna but a short time, soon going to the Uni- 
versity of Pisa. He there made the discovery of the spiral character 
of the heart muscle. It seems that Malpighi was not only an unusually 
careful and accurate observer, both original and profound, but that he 
was a physician widely sought by the most eminent people of his day. 
In 1661 he published a paper describing the structure of the lungs in 
about the same way that their structure is understood at the present 
time. Previous to this time the lungs had been looked upon as a great 
mass of parenchymous tissue with no thought of the air spaces which 
they contained. The next year Malpighi described the circulation of 
blood through the lungs of a frog. In 1663 he began his work on the 



296 SHORT BIOGRAPHIES 

structure and character of the skin. Soon after, he demonstrated the 
mucous layer or pigmentary layer of the skin, intermediate between 
the true and scarf skin. He had separated this layer by boiling and 
maceration and described it as a reticulated membrane. Even its exis- 
tence was for a long time denied by other observers but it remains in 
modern anatomy under the title of the Malpighian layer. 

His next important work was a monograph on the structure of 
the silk worm. Until this time practically nothing was known of the 
structure of the bodies of insects. Working with apparatus which we 
would consider too crude for practical use, Malpighi demonstrated the 
existence of a circulatory system in the silk worm. He worked out 
its respiratory system and its reproductive system. His investigation 
of the urinary system was so accurate that future naturalists coupled 
his name with the tubes of this system, and to the entomologists of the 
present time the term "Malpighian tubule" is a common name. 

From 1675 to 1679 Malpighi appears to have devoted his time al- 
most exclusively to vegetable histology. Ninety-three of his draw- 
ings are of such beauty and accuracy that they might be used as 
illustrations in a modern text book. During the time that his attention 
was principally devoted to vegetable histology he turned aside for 
some work in embryology. Much of his work was done on the chick, 
and again his drawings were of great beauty as well as being remark- 
ably accurate. At the time of Malpighi it was very commonly be- 
lieved that the embryo existed, already formed in the egg, in somewhat 
the same way that the embryonic plant may be found in the ripened 
seed. Malpighi showed conclusively that this is not the case and that 
the embryo developed by a process of evolution. 

Like many others of the world's great workers, Malpighi never 
enjoyed robust health, and in 1694 he died. Malpighi was a great 
naturalist, but of a new type; he began to look below the surface 
and essayed a deeper level of analysis in observing and describing 
the internal and minute structure of animals and plants, and when he 
took the further step of investigating their development he was antici- 
pating the work of the nineteenth century. 



ANTONY VAN LEEUWENHOEK 297 



ANTONY VAN LEEUWENHOEK. 

(Van Luh'-wen-hook.) 

Antony Van Leeuwenhoek was born in the city of Delft, Hol- 
land, in the year 1632. Ninety-one years later, in 1723, he died not far 
from the city of his birth. 

He was a contemporary of Malpighi, and each knew at least 
something of the work of the other. Van Leeuwenhoek was not a 
physician, but his work was so closely associated with anatomy and 
histology that no history of medicine would be complete with his name 
omitted. 

While Malpighi enjoyed the advantages of careful university 
training, Van Leeuwenhoek appears to have been entirely without 
this training. His lack of systematic training is shown in the desul- 
tory character of his work. 

It seems that Van Leeuwenhoek was not obliged to give any 
special consideration to the matter of getting a living. He was a 
man of wonderful industry, but he worked because of his love for 
work rather than for the profit to be derived from it. His best work, 
aside from his work as an observer, was as a maker of lenses. These 
lenses were made of quartz and other natural crystals as well as of 
glass. He used no fewer than two hundred and forty-seven in his 
own work. These varied in their magnifying powers from forty to two 
hundred and seventy diameters. In harmony with the luxurious 
fashion of the times many of his lenses were mounted in silver and 
some in gold. 

In 1673 he was elected a member of the Royal Society of London, 
and in this society he came to be known as the "man of many letters/' 
for his communications recounting his scientific discoveries were in 
the form of letters rather than in more formal papers. In 1686 he 
demonstrated the presence of capillaries between the arteries and veins 
in the tails of tadpoles. His own account is as follows: 

"A sight presented itself more delightful than any mine eyes had 
ever beheld; for here I discovered more than fifty circulations of the 
blood, in different places, while the animals lay quiet in the water and 
I could bring them before my microscope to my wish. For I saw not 
only that in many places the blood was conveyed through exceedingly 
minute vessels from the middle of the tail towards the edges, but that 
each of the vessels had a curve or turning and carried the blood back 



298 SHORT BIOGRAPHIES 

towards the middle of the tail, in order to be again conveyed to the 
heart. Hereby it plainly appeared to me that the blood vessels which 
I now saw in the animal, and which bear the names of arteries and 
veins, are, in fact, one and the same ; that is to say that they are properly 
termed arteries so long as they convey the blood to the farthest ex- 
tremities of its vessels and veins when they bring it back to the heart. 
And thus it appears that an artery and a vein are one and the same 
vessel prolonged and extended." 

He continued his observations on the blood and circulation for 
a considerable length of time, but although he may not have been 
the first to discover the blood corpuscles, he was certainly one of the 
earliest and most critical observers of them. 

He first observed and recorded the branching character and 
nature of the muscles of the heart, and so far as is known he was the 
first to observe the striation in the skeletal muscles, and he was the 
first known writer who gave careful attention to the microscopical 
forms of life found in water. His description of the various forms of 
these animalcules is interesting and is given in very quaint language, 
as the following extract will illustrate : 

"In the year 1675 I discovered living creatures in rain water 
which I had stood but four days in a new earthen pot glased blew 
within. This invited me to view this water with great attention, 
especially those little animals appearing to me ten thousand times less 
than those represented by Mons. Swammerdam and by him called 
waterflies or water lice, which may be perceived in the water with the 
naked eye. The first sort by me discovered in the said water I divers 
times observed to consist of five, six, seven or eight clear globules, 
without being able to discover any film that held them together or 
contained them. When these animalcula, or living attorns, did move 
they put forth two little horns, continually moving themselves; the 
place between these two horns was flat though the rest of the body 
was roundish, sharpening a little towards the end, where they had a 
tayle near four times the length of the whole body, of the thickness 
(by my microscope) of a spider's web, at the end of which appeared a 
globule of the bigness of one of those which made up the body ; which 
tayle I could not perceive, even in very clear water, to be moved by 
them. These little creatures if they chanced to light on the least fila- 
ment or string or other such particle, of which there are many in the 
water, especially after it has stood some days, they stood entangled 
therein, extending their body in a long round and striving to disen- 



GEORGE COMBE 299 

tangle their tayle ; whereby it came to pass that their whole body, left 
back towards the globule of the tayle which then rolled together ser- 
pent-like and after the manner of copper or iron wire that, having been 
wound around a stick and unwound again, retains these windings and 
turnings." Such is the first known description of the beautiful bell 
animalcule. 

His description of vegetable tissue shows that he almost antici- 
pated the later discovery of the cellular structure of plants. While 
he was not the discoverer of the spermatozoa of animals, he was the 
first who gave any exact account of those cells. We need not be 
surprised to know that he greatly misunderstood their signification 
and believed that they represented the living organism of the next 
generation and that the maternal part of reproduction consisted in 
simply furnishing the nidus or bed in which these organisms might 
develop. 

These remarkable discoveries made by Leeuwenhoek with his 
crude apparatus act as a constant rebuke to the investigators of today 
for not accomplishing more when supplied with the magnificent in- 
struments which are now accessible. 



GEORGE COMBE. 



George Combe was not a physician, nor did he ever receive any 
special medical training, but he was a doctor (teacher) of health, 
both mental and physical. Like many other men who lived before 
their time, he was not fully appreciated by his own generation, but 
innovators usually are obliged to wait for future generations fully to 
appreciate their labors. The subject of this sketch belongs to the lat- 
ter class, and, on account of his unpopular system of mental philoso- 
phy, he is not yet so well known in education as he will be in the next 
century. 

George Combe was born in Edinburgh, October 21, 1788, and 
died in the same city, August 14, 1858. He belonged to the middle 
class of society. His early education was received in the parish schools 
of Edinburgh. In 1797 he was entered as a student in the high school 
of that city, and in 1802 he entered the humanity class under Prof. 
John Hill, in the University of Edinburgh. 

Early in life, Combe began the study of the philosophy of the 
human mind. While still a youth, he read the works of Locke, Francis 



300 SHORT BIOGRAPHIES 

Hutcheson, Adam Smith, David Hume, Dr. Reid and Dugald Stewart. 
He was not entirely satisfied with the philosophy of these writers and 
it occurred to him that he who would understand the philosophy of 
the mind must have a thorough understanding of the brain and cen- 
tral nervous system. This led him to become a profound student of 
the anatomy of the brain. As we read his philosophy, we cannot help 
feeling that he would most keenly have enjoyed our modern methods 
of work and preparation. Could he have used our Golgi method of 
tracing nerve tracts, it would probably have clarified many of his ideas 
in regard to the brain and brain structure. 

The book of Combe which is probably the most widely known and 
which has exerted the most profound influence upon thought is his 
"Constitution of Man." In this work he discusses at length the rela- 
tion of man to external objects. Although it was published more than 
seventy-five years ago, it is probable that no one has more clearly 
analyzed the nature of the human mind and the relation of the differ- 
ent faculties to each other. No one can read this remarkable book 
without more clearly appreciating his relationship to external nature 
and to his fellow man ; and while a profounder knowledge of anatomy 
and physiology may modify some of the views held by Combe, it is 
hardly probable that his fundamental philosophy will ever materially 
be changed. It is not our intention in this series of biographical 
sketches to specially advertise any book, but we feel that this book is 
of such exceptional value that every one should make it a point to 
read it. 

It is interesting to know that George Combe was at one time 
offered a professorship in the University of Michigan. We cannot 
help wishing that he had accepted this position, for it is quite likely 
that there would have been a better opportunity for full development 
in the free air of the West than in Scotland, where the greater portion 
of his life was spent. 

His works on education were collected and edited in 1869 by 
William Jolly, Her Majesty's Inspector of Schools. They are now 
published in a large volume of 850 pages by MacMillan & Co. We 
feel safe in saying that George Combe was one of the most enlight- 
ened and enthusiastic educationists Britain has produced. Great as 
has been his influence as a thinker and philosopher, his services to edu- 
cation have scarcely been less notable, and will be of enduring value. 

It may be predicted with certainty that George Combe will yet 
take a high position, not only as a pioneer, but as a permanent power 



JOSEPH LISTER 301 

in education. In the more exact and scientific investigation into the 
problems of education, it is not too much to say that few have sur- 
passed him. George Combe was writing on the science of education 
in the early part of the century, when very few were engaged in that 
work ; and there is no doubt that he was one of the earliest of the few 
investigators in the science of the human mind, who, like Spurzheim, 
Spencer, Carpenter, Bain, and others, have endeavored to render it 
truly philosophical. Combe was one of the earliest to advocate and 
welcome the establishment of normal schools in Great Britain. He 
was also one of the first to urge their erection in America, the first 
normal school in this country being at Lexington. 

A part of the justification for this sketch of Combe is based upon 
the fact that he was a rationalist in every sense. His whole influence 
upon the medical profession was to do away with empiricism, and 
substitute for that, scientific diagnosis and rational treatment. One 
cannot read his writings along the line of psychology and physiology 
without feeling that he was laying the foundation for the rationalism 
which has blossomed in our own day under the name of osteopathy. 



JOSEPH LISTER (LORD LISTER). 

Dr. Joseph Lister was born in England in 1827. He came of 
good stock, and although his father was a merchant he was at the 
same time deeply interested in scientific pursuits, and it was in the 
year that his son Joseph was born that he succeeded in measuring the 
red blood corpuscle and that he observed the tendency of the red cor- 
puscles to form themselves into roulaux. 

Lister graduated from the University of Cambridge in his twen- 
tieth year, 1847, and five years later he obtained his degree of Doctor 
of Medicine. 

The first scientific work which Lister did was on the eye and as 
the result of his investigation of this organ, he found that the muscle 
fibers of the iris were of the unstriated variety of muscular tissue. 

In 1861 Listen began his work as a surgeon. In this year he was 
appointed Chief Surgeon to the Glasgow Royal Infirmary. The in- 
vestigation which he began while connected with this institution 
divides the history of surgery into two great parts: One part is the 



302 SHORT BIOGRAPHIES 

history of surgery before Lister, the other part is the history of 
surgery after Lister. 

He records that he was stimulated into the line of investigation 
which finally led to antiseptic surgery by the fact that the average 
death rate in the hospital was five each week from amputation of limbs. 
His first published statement in regard to wounds is: "The cause of 
suppuration and septicemia in wounds is due to the decomposition of 
blood and serum retained within them, brought about in some way 
through the influence of the atmosphere." This statement was made 
in 1862 or 1863. Soon after this Pasteur began his great work and, as 
a result of Pasteur's investigations, it was found that what Lister 
attributed to the atmosphere was really due to bacteria which were 
floating in the atmosphere. 

Lister devoted thirty years to almost continuous work and investi- 
gation before the idea of antiseptic surgery was fully evolved. In 
other words, it was not until some time after 1890 that antiseptic 
surgery as we now understand the term was plainly taught by Lister. 
His own records show that the mortality in his cases of major surgery 
from 1864 to 1867 was fully fifty per cent, but as early as 1867 he 
had so far advanced on the road of antiseptic surgery that between 
1867 and 1869 his death rate had fallen in the same character of cases 
to fifteen per cent. 

The spirit of conservatism is so strong, even among the highly 
educated, that Lister's ideas of antiseptics made their way very slowly 
and in the face of the most strenuous opposition. The several steps 
in the universal acceptance of his views are the steps which almost 
invariably mark progress. Surgeons at first vehemently denied the 
truth of his statements. Then came the time when they admitted that 
what he said might be true, but that it did not make any difference, and 
we are now living at the time when every medical student is being 
carefully trained along the lines laid down by Lister, but so far as 
they know, people have "always" held the views which they are im- 
bibing. The intelligent osteopath certainly should draw a little in- 
spiration from Lister's experience. However strongly we may be 
opposed and however bigoted our enemies may be, they certainly can 
say no worse of us than they said of their own great teacher. The 
universe is sound at heart and its plan is such that error eventually 
dies and truth is absolutely immortal. 

Of course we are all looking forward to the day when medical 
schools shall give way to the medical profession. That day, however, 



ELIE METCHNIKOFF 303 

must not come until many more scientific questions are settled. Unity 
must come not from any species of compromise, but from a universal 
conviction that some method is right. Any peace, except the peace 
that comes from triumph of principle, is no peace. It is such men as 
Lord Joseph Lister who help to bring about unity which rests upon 
the sane basis of absolute knowledge. 



ELIE METCHNIKOFF. 



Each age has its own standard of greatness, and if we would be 
just we must judge men not by our own standards, but by the stand- 
ards of the age in which they lived. The Hun, Attilla, is said to have 
built a monument to himself in the form of a pyramid out of the 
human skulls taken from those whom he had slain. Judged by the 
standard of his own people he could have had no greater monument. 
We are fortunate in living in an age when we regard the man who 
saves life as being much greater than he who destroys it. 

Elie Metchnikoff* was born in Southern Russia in 1845 and he 
is consequently 67 years of age. He is described as being short of 
stature, strong of build and a tireless worker. Like Louis Aggasiz, 
he has never "had time to get rich," though it is perhaps needless to 
add that he has had numerous opportunities for doing so. 

The course of thought of the true scientist reminds one a little 
of the modern aviator. In his flight through the air the aviator knows 
nothing of artificial geographical boundaries. He passes from one 
state to another or from one country to another, thinking little of 
artificial divisions. In somewhat the same way, the true scientist 
knows little of the artificial boundaries of the several sciences, but in 
his work he seeks an end, caring little whether or not he keeps within 
the limits of the science which originally inspired the investigation. 
Neither Metchnikoff nor Pasteur achieved their highest success along 
the lines of the special sciences in which they were first educated. 
Pasteur began his life work as an inorganic chemist, and it was not 
until he observed that yeast regularly destroys one kind of tartaric acid 
and has little or no influence on another kind that he turned his atten- 
tion to biology. Metchnikoff began his life work as a zoologist and 
his interest largely centered round the invertebrates, and it was while 
studying the circulation of the blood in some transparent microscopical 
forms of invertebrate life that he became interested in the subject of 



304 SHORT BIOGRAPHIES 

phagocytosis, or the destruction of organisms invading the body, by 
the white blood corpuscles. This was in 1882. Somewhat before this 
time Pasteur had conclusively demonstrated the bacterial origin of 
many diseases, and now MetchnikofT was beginning the great work 
of discovering at least some of the causes of immunity. The relation- 
ship of his work to modern medical practice is somewhat the same as 
the relationship of the philanthropist, who studies the cause of pov- 
erty and methods of relieving it, but who drops no penny in the beg- 
gar's hat, is to charity. MetchnikofT gave no time to the treatment of 
people already infected with disease, but he laid a broad foundation for 
the knowledge which shall prevent infection. 

In the two years between 1882 (the date of the discovery of 
phagocytosis) and 1884, MetchnikofT had worked out the modern 
theory of inflammation. Briefly stated, he discovered that an inflam- 
matory condition results from the battle which occurs between bac- 
terial invaders of the body and the leucocytes of the blood which strive 
to destroy them. He had watched each stage of progress from the 
time that the bacteria first begin their invasion of the tissue up to the 
time when they conquer, causing either the death of the individual or 
the destruction of the organ invaded, or when the bacteria have been 
completely devoured and totally destroyed by the leucocytes. In 1895 
MetchnikofT became the director of the Pasteur Institute in Paris. 
Under his direction this Institute has become one of the centers of sci- 
entific medical investigation for the world. This is specially true along 
the line of bacteriology and proto-zoology. 

MetchnikofT is more widely known for his views on dietetics than 
perhaps for any other one thing. It is only just to him to say that he 
has been grossly misrepresented in the daily and weekly papers. In 
his work on inflammation MetchnikofT has shown the supreme im- 
portance of the phagocytes in preserving the tissues of the body from 
invasion. 

Later in his life he believed he discovered that these soldiers 
of the body might sometimes act like the Praetorian guards during the 
last days of Rome. That is, they might unite to fight the body which 
they were designed to protect. In other words, that the phagocytes, 
which in the early part of life are useful in protecting the body from 
invasion, at a later time in life attack the tissues of the body and bring 
about their disintegration ; that they are aided and abetted in this work 
by various kinds of bacteria and that these bacteria may be held in 
check by other vigorous growing bacteria which are incapable of 



ELIE METCHNIKOFF 305 

uniting with the phagocytes for harmful purposes. Having formu- 
lated these views, Metchnikoff began his vigorous and systematic 
search for these bacteria which were to be antagonistic to the harmful 
bacteria of the body, and yet of themselves were to be harmless. He 
observed that while milk and meat were not very unlike from a chem- 
ical standpoint, they are quite unlike in the way in which they yield 
to decomposition. He observed that meat quickly becomes offensive 
and even poisonous, but that milk might undergo profound changes 
without becoming offensive. The bacterium which appears to be the 
most influential in bringing about these innocent changes in milk is 
the bacillus Bulgaricus. He finally came to believe that if this bacillus 
is freely introduced into the alimentary canal it will destroy the bacilli 
there which produce putrefaction and will itself be harmless. Whether 
or not his views upon this subject are sound and final is a question 
which cannot be answered in an off-hand way. Like many other 
hypotheses it probably contains an element of truth without embody- 
ing the whole truth. 

It is pleasing to record that Metchnikoff is greater as a man than 
as a scientist. He is optimistic to a marked degree. The difference 
between the philosophic pessimist and the scientific optimist is finely 
illustrated by two incidents. The German thinker, Schopenhauer, held 
that death is preferable to life; that life, in fact, is not worth living, 
and yet when cholera broke out in Berlin in 1831 he quickly fled to 
Frankfort, but Metchnikoff, the optimist, the lover of life, went fear- 
lessly last summer to Manchuria, into the hotbed of bubonic plague, so 
that he might learn how to diminish human suffering. The difference 
is one between the whiner and the helper. 

In conclusion it is proper to call attention to the fact that no 
scientist of modern times has contributed more to sanity of thought 
along all medical lines than Metchnikoff, and no one has paid less 
attention to the foolish quarrels among the different schools of med- 
ical thought. 

He undoubtedly sees, as do all who have eyes for seeing, that 
the day is not far distant when all different systems of practice must 
merge into one common system. When we think of the amount of 
honest investigation which is being carried on at the present time it 
is impossible to believe that the day is far distant when we shall not 
know the truth regarding the nature and treatment of disease, and it 
is evident that when this time comes the wide difference which now 
separates the several schools of practice must cease to exist. 



306 SHORT BIOGRAPHIES 



ALFRED RUSSEL WALLACE. 

Alfred Russel Wallace was born in 1823 and died early in Novem- 
ber, 1913. At least sixty-four of his ninety-one years were spent in the 
active service of mankind. He was the last survivor of the great group 
of British naturalists whose combined efforts have revolutionized human 
thought. As long as our civilization endures, the names of Spencer, 
Huxley, Darwin, Wallace, Tyndall and Hooker will be remembered and 
revered. No matter how much future discoveries may modify some of 
the views held by these men, the great fact, that they more than others 
formulated the thought of the century in which they lived, will ever 
remain. 

The names of Darwin and Wallace will each be closely associated 
with the discovery of the evolutionary origin of species. Darwin arrived 
at his conclusions while working over the rich collections which he made 
while traveling around the world in the British ship Challenger, and 
Wallace reached almost identical conclusions while living and studying 
amidst the wonderful profusion of life found in the islands of Sumatra 
and Borneo. Neither one knew of the work which was being done by 
the other, and both were ready at the same time to present their conclu- 
sions to a meeting of a scientific society which met in 1858. Neither 
of these eminent naturalists were able to attend the meeting of the 
society and each one confided his paper to his friend Hooker, who pre- 
sented both of these papers which started a revolution in thought more 
far-reaching than any other which has affected modern civilization. 

Wallace, like Darwin, was a prolific writer, and several of the books 
which he wrote in explanation of his views are not only vastly more 
profitable, but are actually more interesting than most modern novels. 
No one can read "Island Life" or "Darwinism" without being pro- 
foundly impressed both by the profound knowledge of the writer as well 
as by his charming literary style. 

During the interesting period when the modern doctrine of evolu- 
tion, now accepted by all thinkers, was making its way against the 
bigotry of the times, Alfred Russel Wallace bore his full share of the 
fight. After the battle was won, while other naturalists were pursuing 
purely scientific investigations, Wallace began to apply the doctrine of 
evolution to humanity and to human culture and his best efforts during 
the last twenty years have been in the line of social evolution rather 



ALEXIS CARREL 307 

than purely biological evolution. He has been interested in every move- 
ment in the last twenty-five years which has been made for the better- 
ment of the human race, and it has been his fortune to live to see his 
views, which were at first violently assailed by almost every public 
teacher in England, accepted as the basis of modern civilization. He has 
lived to see charity, which always caused more paupers than it could 
relieve, placed upon such a basis of intelligence that the time-honored 
declaration that the "poor ye have always with you" may be shown to 
be erroneous. 

He has labored to show that poverty was not to be relieved by freely 
giving while social conditions remained in such a state that a few 
gathered to themselves the product of the labor of the many. Wallace 
and others, stimulated by this thought, have taught us that in a true 
social condition no one lives at the expense of another, but that each 
person makes his contribution to the world and that each one is en- 
titled to that which he himself produces. 

With the death of Wallace there disappears from our civilization 
the last of the great foundation stones. However, the work which they 
did remains, and it is for us to rear upon the foundation which they 
laid a superstructure which shall be worthy of its foundation. 



DR. ALEXIS CARREL. 



Almost everyone has heard of the Nobel prize. This prize is a 
sum of $40,000 which may be given yearly to the one whom the Nor- 
wegian Parliament believes to have done the most for the advancement 
of humanity during a year which has just passed. One can only feel 
that "the wrath of man is turned to praise" when he remembers that 
this prize, which is the interest on money which was accumulated by 
manufacturing dynamite and powder, largely for military purposes, 
was a few years ago bestowed upon ex-President Roosevelt for being 
so largely instrumental in procuring terms of peace between Japan 
and Russia. 

During the present year this prize has been bestowed upon the 
subject of this sketch — Dr. Alexis Carrel. Dr. Carrel is one of the 
workers in the Rockefeller Institute, which was founded several years 
ago by John D. Rockefeller for the purpose of medical research. A 
considerable amount of work, and exceedingly good work, has been 



308 SHORT BIOGRAPHIES 

done in this place. Mr. Rockefeller's attention was especially directed 
to the founding of this institution by the untimely death of a grand- 
child. 

Dr. Carrel's first work was done in the Hull Physiological Labo- 
ratory in the University of Chicago, as early at 1905 ; he began experi- 
menting upon the possibility of transplanting veins and arteries. In 
this line of work he met with considerable success. Time after time, 
sections of arteries and veins were cut from dogs and cats and re- 
placed by sections taken from other animals. The next year he met 
with unusual success in the transplantation of limbs, and in 1907 he 
made the interesting discovery that arteries and veins which had been 
kept for a long time in cold storage could be successfully engrafted 
into living animals. In 1908 it was found that kidneys from one ani- 
mal may be successfully transplanted into the bodies of others. In 
some cases he found that the arteries of the body underwent calcifi- 
cation when new kidneys were engrafted into the animal. As it has 
long been known that there is a close relationship between senility and 
the condition of the arteries, it is hoped that this observation may 
throw some light on the changes in the arterial system that takes place 
in old age. It has been said for some time that one is as old as his 
arteries, and that if some means can be found by means of which the 
arteries may be prevented from senile degeneration, that the period of 
youth may be correspondingly prolonged. Certainly the work which 
Dr. Carrel is doing promises to throw some light upon this important 
question. 

Personally, Dr. Carrel is very far from the kind of man so often 
pictured as the typical scientific investigator. He is far more than 
ordinarily interested in literature and sociology; and he is particularly 
interested in certain phases of psychology. 

The question of the influence of mind on the body, especially in 
all that relates to medicine and the wonderful physical conditions that 
sometimes follow strong influences exerted upon the mind, have al- 
ways had especial attraction for him. Those who know him inti- 
mately think of him as a charming man of the world, with none of 
that self -absorption that is supposed to characterize the man who 
crosses the border line into the unknown in science and makes a path 
which others may easily follow. It will pay us to watch Dr. Carrel's 
course in the future, for it is he and others like him who are working 
to increase our knowledge in regard to the human body and its 
mysteries. 



WILLIAM CROOKES 309 



SIR WILLIAM CROOKES. 

Sir William Crookes has recently been elected president of the 
Royal Society of Great Britain. This great honor is the fitting crown 
of a long and useful career. Sir William Crookes is now eighty-two 
years old, and he has been a member of the society of which he is now 
president for fifty years. 

Modern chemistry has been mostly developed during his lifetime 
and he has recorded its development in the "Chemical News," a jour- 
nal which he founded in 1859. He not only recorded the history of 
chemistry, but he went far toward making its history, as he has been a 
most prolific discoverer in the chemical field. No branch of chemistry 
was too humble and none too abstruse to receive his attention. For 
years he guarded the health of London by constant chemical examina- 
tions of its water and sewage. 

He has shown that the atom is divisible and has thus overthrown 
established theories of the constitution of matter. He has lived to see 
the world accept his views which at first were almost universally re- 
jected. Some years ago he expressed the opinion that all of the ele- 
ments are but different forms of some primordial substance which he 
calley "protyle," and that the atomic weight instead of being one of 
the "constants of nature," is "a mean value around which the actual 
weights of the atoms vary within certain limits." This variation is 
especially true of the atoms of some of the metals of the rare earths. 
In 1900, Crooks proved the transmutation of some of the elements by 
extracting the radio-active element "Uranium X" from the mother of 
elements, Uranium. The beautiful "Crookes tubes" are known over 
the civilized world. In these, Crookes has contended, there is matter 
which differs from solids, liquids and gases as much as these differ from 
each other. His "rare earths" are rare no longer. Thoria and Ceria 
make our gas mantles. Almost every department of life has been en- 
riched by his activities and we hope that his years may yet be prolonged. 



310 SHORT BIOGRAPHIES 



WILLIAM J. HAYDEN. 

Dr. Wm. J. Hayden died very suddenly on the morning of January 
6th, 1914. His death in many respects took upon itself an ideal form. 
His last earthly work was done at ten o'clock or later on the preceding 
evening and he died before the rising of the sun the next morning. It 
must ever be a pleasant thought for his friends that his last work was 
done along professional lines for the purpose of relieving human suffer- 
ing. His death was caused by a heart trouble probably known for some 
months by himself but entirely unknown even to those most closely 
associated with him. 

Dr. Hayden was born in Missouri and was educated in one of her 
State normal schools and was, for some time, a successful teacher. He 
graduated from the Pacific College of Osteopathy in 1899 and imme- 
diately entered upon active practice in partnership with his wife, 
Daisy D. Duffey, whom he had recently married. He was one of the 
earliest osteopathic physicians to see the possibilities of the profession, 
and in 1909 he went abroad in company with his wife, Dr. Daisy D. 
Hayden, to further fit himself for surgical work. While in England 
he completed post-graduate courses in surgery in the West London 
Hospital and in the Seaman's Hospital, while she devoted her time to 
obstetrics and children's diseases. From there they went to Vienna, 
where they further enriched themselves in the great Polyclinic of that 
city. On their return to Los Angeles, they again resumed a general 
practice, but Dr. W. J. Hayden's skill as a surgeon became rapidly 
known and at the time of his death he had an ever-increasing practice 
in that department of medical work. 

When the Pacific College of Osteopathy was reorganized under the 
educational laws of the State of California, Dr. Hayden became not only 
a member of the incorporation, but was made President of the Board of 
Trustees. For ten years previous to this time Dr. Hayden had main- 
tained a close relationship with the college, and the good work which 
is now demanded in respiratory diseases is due very largely to the 
foundation which he laid when he lectured on that subject. 

As a college man, Dr. Hayden was cautious but also progressive 
and he counselled wisely in many of the most important advances 
which the college has made. As a practitioner, Dr. Hayden was greatly 



WILLIAM J. HAYDEN 311 

beloved by his patients. Many cases of kindness and sympathy for 
those who were wholly unable to pay for his services have come to light 
since his death. He was pre-eminently disinclined to reveal to the 
public his inner and best life, and his tendency toward unselfish care 
for others is much better known since his death than when he was living. 

Two years ago Dr. Hayden was appointed one of the clinicians in 
the Parent-Teachers' Clinic of Los Angeles and in this position his 
love for children and his care for the helpless found a fine field for 
development. His place in this line of work will be a difficult one to 
fill. As a friend Dr. Hayden was dependable and singularly helpful. 
Many of our young practitioners owe much of their success to his 
kindly help to them when they were entering upon practice. While 
he was diligent in business, he was free from all mean and petty 
jealousy and he never seemed to feel that the success of his neighbor 
would in any way detract from his possibilities for success. He was 
a broad-minded, just and patriotic citizen and while he never sought 
civic honors or place, he never failed to express himself upon all 
questions relating to the public welfare. He leaves a rich heritage 
not only to the profession in this state, but to the country at large. 
The skillful physician, the kind friend, the manly man, the patriotic 
citizen is dead, but his memory lives and the good that he has done 
falls into that great stream which passes down the ages. The indi- 
vidual will be forgotten, but the good influence which he exerted will 
live as long as humanity preserves its virtue. 

"After life's fitful fever he sleeps well." 



APPENDIX I. 

The following report is reprinted for convenience in comparison 
with the articles on "The Opsonic Index," page 190, and "The Phago- 
cytic Index," page 194. 



*THE OPSONIC INDEX AS AFFECTED BY MECHANICAL 
STIMULATION. 

Early in September, 1909, I started a series of experiments to de- 
termine the effect, if any, which the mechanical stimulation of the 
liver might have upon the phagocytic power of the leucocytes as deter- 
mined by the Opsonic Index. Before attacking this problem I was 
obliged to make a few preliminary investigations. 

A series of experiments convinced me that the caliber of the 
opsonizing pipette, providing its size is kept within ordinary limits, is 
not an important factor in phagocytosis. I also found, as a result of 
considerable experimentation, that the phagocytic power of the leuco- 
cytes is retained without appreciable diminution for at least twenty- 
four hours, providing they are kept at ordinary room temperature. I 
also found that blood serum kept at room temperature, and safely 
sealed from all organic matter, undergoes little or no appreciable 
change in its opsonizing powers in twenty-four hours. 

Having established these preliminary facts, I made a series of 
experiments in the following way: I secured by own leucocytes, 
thoroughly washed in normal salt, and also my own blood serum. I 
then submitted to a strong stimulation of my liver, both through the 
innervation (this stimulation being given through the back) and a 
direct mechanical stimulation given by thorough massage immediately 
over the organ. Immediately after this treatment I again secured my 
own blood serum, and using the serum obtained before treatment as 
a control, proceeded to secure the opsonic index. Using the control 
serum in the same way, I also made the opsonic index from serum ob- 
tained several hours after the treatment had been received. 

In all of these cases the meal question was constant, as I was 
taking only a light breakfast and then eating nothing until the evening 
dinner. As this work was done in the somewhat uncertain intervals 



♦Bulletin No. 1, A. T. Still Research Institute. 



OPSONIC INDEX 313 

incident to one engaged in active teaching, I can make no claim to 
my work being absolutely free from error; but as I observed every 
precaution which I could, and as the results are somewhat uniform, 
I venture to offer the report for what it is worth. It is, of course, 
quite possible that further work, especially if carried on under more 
favorable conditions, might show some changes in the results. The 
work was carried on during the winter of 1909-10 in the laboratory 
of the Pacific College of Osteopathy, the exact dates being given in 
the following table. In this series of experiments I used an emulsion 
of killed bacilli of tuberculosis : 

Opsonic Index one-half hour after Opsonic Index some hours (as given) 

stimulation. after stimulation. 

Index .98 November 2 After 4 hours, 1.4 

" 1.1 November 8 " 4 " 1.3 

.99 November 30 " 4 " 1.1 

" 1.2 December 6 " 5 " 1.2 

" 1 December 14 " 4 " 1.4 

" 1.1 December 21 " 4 " 1.3 

.99 January 12 " 6 " 1.1 

.76 (?) January 18 " 4 " 1.6 

.95 January 27 " 4 " 1.0 

" 1.2 March 9 " 4 " 1.2 

" 1 March 23 " 3 " 1.2 

" 1.1 April 13 " 4 " 1.4 

" 1 April 21 " 5 " 1.3 



APPENDIX II. 

The following reports were written from memory. The lectures 
were given at the end of two or three hour periods of laboratory 
work, during which the tissues under consideration were studied by 
students, and were made the subject of informal discussion and com- 
parison. The short lectures which brought the laboratory periods to 
a close were for the purpose of applying and explaining the labora- 
tory findings. These particular subjects have been included here, not 
because they are supposed to be of more value than hundreds of other 
such talks, but because they are more clearly remembered. 



BIOLOGICAL RELATIONS— STARCH. 

The leaves which you have been examining show the masses of 
chlorophyll as small granules within the cells which make up the struc- 
ture of the leaf. This chlorophyll is at the very foundation of life, as 
we know it, upon the earth. It is the little things of life that count 
most, it seems, and these masses of chlorophyll illustrate this saying 
in a very good way. 

Chlorophyll has the property of being able to make use of the rays 
of the sun as a source of energy, and by means of this energy to build 
up water and carbon dioxid into starch — or rather, into the glucosides 
from which starch can be made. In the process of making this sub- 
stance, oxygen is set free, and this is used by animals and by the cells 
of plants, as a source of energy. In other words, there is a continuous 
cycle going on in regard to the oxygen transformations — the chloro- 
phyll builds up the carbon dioxide, or carbonic acid gas, as it used to 
be called, with water, into the glucosides, and the plant cells complete 
the formation of starch granules. Free oxygen is breathed out by the 
plant into the surrounding atmosphere. The chemical equation is : 

5H 2 + 6 C0 2 = (C 6 H 10 O 5 ) + 12 0. 

Animals eat the starch, and breathe the air which contains the free 

oxygen. They utilize the starch as a source of energy — for muscular 

effort, for maintaining the heat of the body, and, to a certain extent, 

for building up the tissues of their own bodies. In order that they 



BIOLOGICAL RELATIONS— STARCH 315 

may utilize the starch — or, rather, the glucose into which the starch is 
converted — as a source of energy and heat, it is necessary that it be 
oxidized, and this reaction is performed by means of the air that the 
animals breathe, which contains oxygen which may have possibly been 
derived from the formation of the starch which the animal has eaten. 
The starch is transformed by the cell of animals, of certain plants, 
by bacteria or by enzymes, into glucose, 

C 6 H 10 O 6 + H 2 O = C 6 H 12 O 6 

This monsaccharid (simple sugar) is oxidized into carbon di- 
oxid and water, 

C 6 H 12 6 + 12 = 6 H 2 0+6 C0 2 

The carbon dioxid is breathed out into the surrounding air by 
the animal, together with at least a part of the water in the form of 
vapor, and these substances are then ready to be again taken up by 
plants, and built again into starch with the evolution of free oxygen. 
The place of chlorophyll is thus a most important one in the history 
of life upon the planet. By means of this humble servant the tre- 
mendous energy contained in the rays of the sun is made available for 
use by animals. 

It must not be forgotten that those cells of the plant which do not 
contain chlorophyll use oxygen and starch in their own metabolism in 
very much the same way that animals use these same substances. There 
is thus a reason why growing plants are not suitable decorations for 
rooms which are inhabited at night, since the plants use up oxygen 
in the darkness, but they are most pleasant and useful in living rooms 
which are sunny, because they use up the carbon dioxid of the air, and 
add oxygen to the air. It must be said, also, that these considerations 
are more theoretical than real, since the amount of carbon dioxid given 
off by any of the plants ordinarily kept in dwelling houses is extremely 
small, and the amount of oxygen which such plants give off is, also, 
practically negligible. 

Starch is one of a complex series of compounds which are of 
great use to most animals and plants, and which are related to one 
another in ways not yet very clearly understood. Starch granules are 
formed through the agency of living cells under very different con- 
ditions. The tubers of many plants are composed almost altogether 
of starch, which has been formed by the living cells in that location, 
from the soluble substances formed in the leaves, etc., of plants, and 
carried down into the roots by means of the circulating sap. Cellulose, 



316 APPENDIX II. 

of which the plant tissue is composed, is closely related to starch, but 
is much more compact in structure. Cellulose cannot be digested as 
easily as starch; the human being is usually unable to digest it at all, 
though it forms the chief food of horses, cattle, and certain other 
animals. In the human digestive tract it is possible that bacteria may 
act upon cellulose, and that in this way a certain amount of nutrition 
may be derived from it, but the chief value of the vegetable foods which 
contain cellulose in abundance is due to the fact that such vegetables 
contain salts necessary to the body, and also to the fact that the cellu- 
lose gives bulk to the digesting food mass, stimulates peristalsis, and 
thus promotes the digestion of other food elements. 

Glycogen, sometimes called "animal starch," is deposited in the 
liver and in the muscles. Glycogen can be manufactured from proteid 
foods as well as from the starches and sugars of the food. Glycogen 
is again changed into sugar, and thus made available for use by the 
body when the sugar content of the blood becomes diminished. Dur- 
ing starvation, it seems that the glycogen disappears from the liver and 
from the muscles first of all, and the fats of the body are used after- 
ward. Glycogen is of interest also in connection with certain patho- 
logical degenerations, to which I shall call your attention at some 
future time. 



BIOLOGICAL RELATIONS— NITROGEN. 

Another foundation for the structure which makes life possible is 
found in activities of the nitrogen-fixing bacteria. The nodules which 
you have been examining, which are growing upon the roots of the 
bean, pea, alfalfa, and clover, are due to the presence of these bacteria. 
These illustrate the condition known as "symbiosis" by which we under- 
stand a condition in which two organisms live together, one supported 
by the other, and giving some advantages to its host. In this case, 
the plant — always some member of leguminous family, to which these 
plants you have been examining belong — is the host. The bacteria 
live upon these roots, as is the case in most infections, but in these 
particular infections the bacteria are of advantage to the hosts, and, in 
a way, pay their board, if the saying may be taken in a very indefinite 
way. The nitrogen-fixing bacteria have the power of using inorganic 
nitrogen as food for themselves, and thus, by combining nitrogen into 
an organic compound, they make this most necessary element of 
protoplasm available for use by higher animals and plants. 

Leguminous plants are those which bear seeds in pods, and which 



BIOLOGICAL RELATIONS— NITROGEN 317 

have ten stamens,, arranged in two groups, one of which contains 
nine stamens, while the other is composed of a single stamen. The 
blossom of the plant is also characteristic, and this is shown conspicu- 
ously in the familiar blossom of the sweet pea, and that of the locust 
tree. All of these plants are subject to infection by the nitrogen-fixing 
bacteria, and for this reason they are able to grow in very poor soil, 
and to make the soil richer by the very fact of their growth upon it. 

The story of nitrogen, from its place in the atmosphere, of which 
it forms about four-fifths, is something like this : 

Atmospheric nitrogen permeates the soil, especially where it is 
loose, and thus it comes into relation with various salts. During 
storms, as the result of the electrical energy, and perhaps in other ways 
not yet well recognized, the nitrogen unites with hydrogen from water 
to form ammonia. This ammonia, carried into the soil, unites with 
the salts of the earth to form various inorganic nitrates. The nitrogen- 
fixing bacteria are able to use these inorganic salts, and possibly also 
the free nitrogen, in the formation of their own protoplasm. The or- 
ganic material thus provided is used by the leguminous plants which 
the bacteria infect; the plant is used as food for animals, or it is al- 
lowed to decay in the soil, making the soil sufficiently rich in the or- 
ganic nitrogen compounds for other plants to grow upon. 

The whole process of animal and vegetable life, the existence of 
even the highest types of animal life, even to the brain of the human 
being, is thus seen to be built upon a foundation laid down by the activi- 
ties of two remarkable organisms, — the chlorophyll of green plants, 
and the nitrogen-fixing bacteria of the roots of the leguminous plants. 
The first utilizes the energy of the rays of the sun in the formation of 
the oxidizable carbohydrate compounds, which thus represent poten- 
tial energy, and which give the energy to cells and to individuals, and 
which help to make up the protoplasmic molecule; the other provides 
for the utilization of the great sea of nitrogen around the earth in the 
formation of the protoplasmic molecule, by means of which the ex- 
tremely complex and unstable and changeable chemical syntheses and 
analyses characteristic of the living cell become possible. Without 
these two humble servants, life as we know it upon this earth would 
perhaps be utterly impossible. 



318 APPENDIX II. 



ADAPTATIONS. 

The history of life upon the earth is a history of constant battles. 
Varying relationships of living creatures with one another, and of 
these with the inorganic world, have compelled the development of 
most remarkable adaptations. This is illustrated plainly in the history 
written upon the shores of the lakes in Utah and Nevada. Here, the 
lakes have undergone great changes during the geological eras. Periods 
of considerable rainfall filled up these lakes, which have no outlet, with 
fresh water; periods of scanty rainfall permitted the gradual evapor- 
ation of the water, until the lakes became progressively more salt. 
The history of these climatic changes is shown in the varying char- 
acter of the shells left upon the beaches at successive levels. Fresh 
water forms are numerous in the deposits made during the periods of 
plentiful rainfall. During the gradual increase in the salt content of 
the water, the character of the animals living in the water changed, 
until finally only those organisms which were able to live in quite 
strong salt solutions left any records in the beach levels formed during 
periods of scanty rainfall. 

There is, in the flora and fauna of any country, a sort of natural 
balance, by means of which various infections, various insects, animals 
and plants act and react upon one another. Parasites may attack 
plants, but there is usually some insect to attack the parasite; birds, 
in turn, may live upon the insects and carry the seeds of the 
plants. Other animals may attack the birds, eat the plants, and, in turn, 
yield to the invasion of bacteria or parasites of other kinds. 

Such a balance of power in life can be secured only at the ex- 
pense of many a battle field. No doubt organisms have gained a foot- 
hold in every country, only to be forced to the wall, and finally to 
extinction, by the presence of disastrous and overpowering attacks 
made by other forms of life. Sometimes instead of dying, the organ- 
ism develops some defensive armor, and what seems to be some new 
specie is produced. This can be done artificially with remarkable re- 
sults; practically all of our domestic fruits and vegetables have at- 
tained their present great size and delicious flavor as the result of gen- 
erations of selection and experimental cross-fertilization. 

This biological balance is often disturbed by man, — sometimes 
with disastrous results. For example, the Scotch thistle is a rather in- 



ADAPTATIONS 319 

significant and harmless plant, in its home country, but when it was 
carried to Australia by a sentimental traveler, it quickly escaped all 
reasonable limits and became a most destructive pest. A similar occur- 
rence led to the development of a pest of rabbits in Australia. 

The manner in which organisms adapt themselves to adverse ele- 
ments is a most interesting chapter in biological history. For example, 
in almost any locality the rocks contain records of huge animals 
which dwelt there during geological ages. What became of these ani- 
mals? Some of these great forms lived within comparatively recent 
times, geologically speaking, — you remember that in Siberia the flesh 
of the frozen mammoth was used as food by some members of an ex- 
ploring expedition, and that this flesh was very useful as food for the 
dogs of the party. It is not possible to say how many centuries this 
flesh may have been kept frozen, yet it is certain that these great 
animals lived only yesterday, in a geological sense. You have seen the 
tusk of the sabre-toothed tiger, in the collection made by Dr. Frank 
Clark ; this animal must have lived in this country quite recently. This 
specimen, with others, was brought from the asphaltum lake near Santa 
Monica. We can only make the wildest attempts at conjecture as to the 
cause and the manner of death of these extinct animals. The fact 
that remains of insects resembling the tse-tse fly have been found asso- 
ciated with these remains suggests at least the possibility that some 
protozoan, perhaps like the trypanosome Gambiense of sleeping sick- 
ness, may have caused the extinction of whole races of these animals. 

The changes of bodily temperature, — the development of what are 
generally called "warm blooded" animals, which simply means animals 
which maintain a constant and equable body temperature through 
changing climatic conditions, — may have been due to infection by some 
parasite, perhaps something resembling the malarial protozoan. It is 
known that a temperature of about 98° F. kills, or at least inhibits the 
growth, of several of these organisms. This is certainly one factor in 
preventing the occurrence of infections, — for example, fowls become 
subject to several bacterial invasions if they have the body temperature 
lowered before they are exposed to the infection, whereas under normal 
conditions they may be almost or quite immune to the same pathogenic 
organisms. So, in many of the feverish conditions, the raised tempera- 
ture may be an attempt at the destruction of the bacteria. It is need- 
less to say that in many cases the increased temperature injures the 
cells of the body, perhaps injures them more seriously than the action 
of the invading bacteria would injure them, but the fact that increased 



320 APPENDIX II. 

temperature could help to destroy infectious organisms is very probably 
responsible for the development of the higher temperature, — the 
"physiological fever" of birds and mammals. 

It is only a comparison, and must not be carried too far, else it 
loses what little virtue it has as a comparison, but I cannot pass over 
the opportunity of calling your attention to the fact that in the bodies 
of higher animals, and especially of mammals, there is also a sort of 
biological balance of power. The various organs of the body work 
together, according to the rules which have been provided through 
countless ages of adaptation. There is a sort of balance between the 
intake and outgo, between the different internal secretions, between the 
sensory nerve impulses and the outgoing motor reactions, as well as be- 
tween sleep and rest and other physiological activities of the body, 
which enables the members of the human race, and the mammals in 
general, to meet the ordinary emergencies of life in an efficient manner. 
And it is as dangerous to meddle with this balance as it was to take 
the Scotch thistle to Australia. It is a very dangerous thing to inter- 
rupt or to modify the balance between the various structures of the 
body. It is true that the human body is not theoretically perfect, but 
its parts are adjusted so that it works well enough, — probably every 
organ of the body is able to meet not only the ordinary emergencies of 
life, but also some very extraordinary emergencies in an efficient man- 
ner. The removal of organs whose functions are not well known is a 
very dangerous experiment; not only is the functional activity of the 
removed tissues lost to the body, but the balance between the various 
other organs may be seriously disturbed. There are cases in which the 
removal of organs which are badly diseased is necessary, but it is ex- 
tremely important that one should be very certain that this is the most 
rational procedure before he advises the removal of any organ of doubt- 
ful, or even of certain, function. 

The same principle holds true in adding substances to the body. 
Anything taken into the stomach is subject to the action of the digestive 
secretions, and it also may fail to be absorbed into the body, whether 
it is acted upon by the digestive secretions or not. Even the best 
educated of medical physicians "pours medicines of which he knows 
little, into bodies, of which he knows less," and the administration of 
drugs by the mouth is dangerous enough, at the best. Still, by this 
means, the body has some opportunity of protecting itself against their 
ill effects. But recently the use of the hypodermic needle is becoming 
so common, and there is so great a tendency to the use of serums in the 



INFECTIONS 321 

treatment of disease, that the danger of meddling with the organic 
balance of the bodily organs must be strongly emphasized. Substances 
injected into the tissue spaces, and, still more, into the veins, act upon 
the body cells with no check whatever ; the body has no chance to guard 
itself against the invasion; the cells are helpless to protect themselves, 
no matter how injurious the substances injected may be. 

Especially dangerous is the injection of foreign proteids into the 
body. It seems that many of these compounds, which may, indeed, be 
useful articles of food when taken into the body in the ordinary way, 
become intensely toxic when placed directly into the circulation. Not 
only may the immediate effects be bad, but certain complicated changes 
of the body's metabolism may be brought about which lead to most 
disastrous effects at some later time. It cannot be too strongly empha- 
sized that we are running a risk, and a most serious risk, when we dis- 
turb the biological balance of the organic relations of the body in any 
way. 



INFECTIONS. 



(The course in biology included some microscopic study of the 
tissues of plants and of the lower animals.) 

You have all, I believe, been provided with specimens of these 
stems and leaves, each of which shows evidences of various infections. 
In every case, in the plants examined this morning, the infectious agent 
seems to have gained entrance into the deeper tissues of the plant 
through some injury to the protective outer layer. There are certain 
parasites which injure plants and not only gain entrance to the deeper 
tissues for themselves, but also allow bacteria and perhaps other or- 
ganisms to infect the plant. For the most part, however, the bacteria, 
the moulds and the other varieties of infectious agents gain entrance 
into the plant in some such way as you have noticed in these stems, — by 
way of some structural injury to the plant epidermis. 

What is true of plants seems to be true to a great degree of higher 
animals and also of the human body. There are a few bacteria which 
are parasitic, — that is, they are able to live upon the healthy body, or in 
the secretions of the healthy body. But by far the larger number of 
the bacteria which invade the human body are saprophytic, that is, they 
live upon dead organic material primarily, and only are able to exist 



322 APPENDIX II. 

within the body by finding, and later by producing, dead or dying 
tissues. To such bacteria, the healthy body is immune. 

The importance of correct structural relations cannot be over em- 
phasized. Even in plants this is an important factor in guarding 
against infection. Vigorous growth, strong and healthy vitality, go far 
toward preventing infections. Even those infections which are capable 
of attacking trees which appear to be fairly resistant, make a far more 
destructive onslaught upon plants which live in poor soil, which are sur- 
rounded and choked by weeds, and which receive scanty supply of 
water. 

Even more, in the higher organisms, and in mammals and the 
human race, where there is so great complexity of structure and rela- 
tionship, and where certain organs of the body seem to provide anti- 
toxins and other weapons of defense, is it needful that structural rela- 
tions should be maintained in as nearly their normal state as possible. 
We know too little of the body, and of the manner in which it acts 
under normal conditions, much less under the effects of abnormal con- 
ditions, to permit us to interfere with the structural relations hastily. 
There are, apparently, cases in which the presence of serious diseases 
compels the removal of the tonsils, the appendix, and other organs 
whose functions are still somewhat doubtful. It is also true that there 
are conditions of serious diseases which compel the removal of the 
right hand, but one would certainly give very serious thought to the 
matter before he would permit the removal of his hand, whereas the 
removal of the tonsils, the appendix, or other structures which may be 
even more important and necessary to the health of the body may be 
hastily advised with little or no consideration of the possible harm 
that might ensue. 



MODERN DIAGNOSIS. 



In the "good old days that are past," the diagnosis and treatment 
of disease were easy matters. The doctor listened to a recital of 
symptoms, asked a few questions, perhaps looked at the tongue of the 
patient, possibly even counted his pulse and noted its characteristics in 
a vague way, or took his temperature with a clinic thermometer. Then 
he told exactly what the trouble was, wrote a prescription or filled it 
from his case, and the patient either died or recovered, as the case 



MODERN DIAGNOSIS 323 

might be. The drug was supposed to exert a destructive effect upon 
the disease, or a curative effect upon the body. 

This was a pleasant fable, and one which has soothed many a 
dying bed and comforted many a bereaved family. It was a fable 
which has caused many a bed to be a dying bed which should not have 
been a dying bed, and it has caused many a family to be bereaved which 
should not have been bereaved. It cannot be too strongly insisted upon 
that comfort which is derived from things that are not true, and the 
consolation which cloaks facts and precludes investigation must, in the 
very nature of things, lead to further disaster. And the giving of 
words which cloak ignorance, and which lead to a false security and 
which cause us to rest satisfied with an amount of knowledge which 
is insufficient to govern our acts wisely, is a very dangerous thing for 
the race. Ignorance which is recognized may be only a step to better 
things, but the ignorance which is satisfied with itself can only go down 
to certain ruin. It is no disgrace to be unable to name a disease and 
to be unable to outline satisfactory methods of treatment speedily ; it is 
a disgrace to be willing to be satisfied with the false diagnosis which 
rests upon guess work, and to depend upon therapeutic methods which 
are based upon guess work and empiricism and fable. 

Suppose your watch should cease running, or should not run regu- 
larly. You might guess that it needed winding, and try winding it up. 
If it goes along fairly well after that, you suppose that perhaps the 
winding was the thing it needed. You might shake it, and it might run 
fairly well for a few days ; you might guess that a bit of lint had gained 
entrance into the works and blow into the case; the watch might run 
correctly after that. But if you should take your watch to a jeweler 
you would scarcely be satisfied with his skill if he had no better 
methods of diagnosis and treatment than such things as these. You 
expect him to know the mechanism, and to be able to make such exam- 
inations as are necessary in order to find the cause of the condition, 
and to be able either to remove the cause of the disturbance or to tell 
you the nature of whatever irremediable defect he might find present. 
People may tinker with their own bodies, with more or less disastrous 
results, but when they go to a doctor they should expect the advice and 
the treatment that rests upon a certain and exact knowledge of the 
conditions as they are, in the body of the sick person. 

The body is different from most machines in being more delicate 
and more complicated, and also in being so thoroughly guarded from 
examination. We may think of some extremely fine piece of machinery 



324 APPENDIX II. 

in a locked room, and so firmly associated with the walls of the room 
that any attempt to enter the room must necessarily destroy the ma- 
chinery. As long as the machine works all right, and serves its proper 
purpose, there is no need for us to try to go in, but when there is some 
disturbance, it is necessary to find out, if possible, the cause and the 
best manner of securing relief from that disturbance. We may suppose 
that there are a few windows in the walls of the room, and that these 
windows are placed in such a way that each gives a view of certain 
parts of the machine. We would all agree that before trying to advise 
concerning the best method of dealing with any irregularities of the 
running of such a machine, that we should look into as many of these 
windows as possible and that we should employ magnifying lenses, 
and whatever other apparatus we might find useful in making our 
vision more clear and our knowledge more exact. We might analyze 
the fuel and the oil which were being used, in order to determine 
whether any cause of the disturbance might be found in these, and we 
might examine and analyze the ashes and the smoke, in order to deter- 
mine whether the machine was able to make normal use of the fuel 
provided. Now some such thing is true of the body, though the com- 
parison cannot be pushed too far. When there is any disturbance with 
the functions of the body, the first thing to do is to find the cause of 
the disturbance. We can examine the orifices of the body; we can 
listen to sounds which are heard through the walls, the sounds of the 
heart and the lungs, and we may use the various other methods 
of physical diagnosis, etc., which are all capable of giving much 
useful information. We may analyze the urine, and examine 
the sputum, the gastric contents, the blood, etc., and each of 
these examinations is a sort of window by means of which we 
may look into the room and see how the machinery is running. We 
may thus find out the real nature of the disturbance, and its cause, and 
also how best to remedy the condition. We may all agree, too, that 
while it might be that should we look into several windows without 
finding anything of especial interest, that would not be any very serious 
loss, but if we should neglect some window, in our search for a correct 
diagnosis, and that window would happen to be the one through which 
a view of the mechanical error could be seen best, it would be a mistake, 
and a most serious mistake. Indeed, it is quite conceivable that such 
neglect might be the means of failing to provide such methods of treat- 
ment as would be necessary in order to save the life of the patient. 

This is my plea, that every one of us should neglect no source of 



NEOPLASMS 325 

information when we are dealing with sick persons. That while an 
effort to make a careful study of every patient may cause us to make 
some tests which do not add to our knowledge of the case, yet this is 
a very small thing compared with the chance that any one of these ex- 
aminations may give us the information necessary to making the most 
speedy recovery and sometimes to saving life itself. 

Not only is our success in dealing with individual patients assured 
by such careful diagnosis, but such habits go a long way toward placing 
our profession firmly upon a sound scientific basis. 



NEOPLASMS. 



It must be remembered that the cells of which tumors of 
all kinds, both benign and malign, are composed, are derived by the 
ordinary processes of division, from pre-existing cells. The tissues of 
which these tumors are composed, however malignant they may be, 
are invariably of the same type as those found in the body at some time 
in its existence, either at an early time of embryonic life or at some 
later period. There is nothing essentially abnormal in these cells, ex- 
cept the fact of their wild and uncontrolled multiplication. Indeed, it 
may almost be said that there is no such thing as a strictly pathological 
tissue, — by this I mean that every tissue found in the body in the form 
of a tumor is representative of some tissue which is present in the body 
normally at some period of its development. The tissues which make up 
tumors are out of place, and as the result of their abnormal location 
they may depart very widely from their original appearance; yet 
enough of the cell characteristics usually remain to enable them to be 
recognized upon a careful examination. 

Huxley defined dirt as "matter out of place," and we may para- 
phrase this by saying that pathological tissues, and to a great extent, 
pathological phenomena in general, are merely cells and physiological 
phenomena which are out of place. 

Why it is that certain cells of the body begin to undergo this dis- 
astrously rapid multiplication at certain times and under certain cir- 
cumstances, no one is yet able to say. The Cohnheim theory, which 
supposes the existence of what is called an "embryonic rest" has much 
to commend it, though it does not solve all of the problems presented 
by the facts of cancer growth. This you have already considered in 
the earlier part of your work. 



326 APPENDIX II. 

You have noted in the slides and gross specimens which 
you have been studying, that those tumors whose histories have 
been given you have certain characteristics in common; the 
tumors which have been removed on account of the discomfort 
or other symptoms resulting merely from the size of the tumor, 
or from its pressure upon neighboring parts, are, for the most 
part, somewhat harder in texture than the more malignant tumors ; 
they have fairly well marked limits, and appear to have been 
shelled out of the body, — as, indeed, they may have been. The 
patients from whom such tumors have been removed often appear to 
be in reasonably good health, and they recover speedily from the 
operation. In other words, such tumors are called "benign" because 
they are not particularly toxic in their influences upon the general 
health of the body, and almost the only harm for which they are re- 
sponsible is due to their size, and to the mechanical injury they pro- 
duce in neighboring organs. 

Upon microscopical examination, these tumors resemble the tis- 
sues of adult organs. The fibroma resembles adult connective tissue, 
the adenoma resembles adult glandular tissue, the myoma resembles 
adult muscular tissue, and so on. When such a tumor shows within 
its structure cells which resemble embryonic tissue, when the cells are 
engaged in rapid multiplication, when they are thin-walled, have large 
round nuclei, and when the intercellular tissue is very small in amount, 
then there is danger of this tumor's assuming malignant character- 
istics, — and thus it becomes a very dangerous thing to be retained with- 
in the body. This change does occur, not very rarely. It is not possi- 
ble, at the present time, to decide whether the intrinsic cells of the 
tumor change their characters, as the result of their peculiar environ- 
mental conditions, or whether the irritation due to the presence of the 
benign growth stimulates the neighboring cells, perhaps some of them 
embryonic rests, into rapid growth. It is, of course, quite conceivable 
that a malignant growth might be a neighbor, and a very close neigh- 
bor, of a benign tumor. 

There is another series of tumors which have been received either 
from operations or from autopsies, in which the mass presents quite 
different characteristics. In the first place, no recognizable wall is 
found. Only when an organ which itself has a wall, is permeated with 
cancer cells, does there appear anything like a limiting membrane. 
So far as this type of tumor is concerned, it has no limits, but spreads 
diffusely in almost every direction, invading and destroying the 



NEOPLASMS 327 

neighboring tissues, much as the embryonic glands and blood-cords 
invade and occupy the neighboring mesoblast. 

You will notice also that these soft tumors have very marked and 
tortuous and dilated blood vessels. Also, there is a tendency for these 
tumors to break down, and, if infection occurs, to undergo suppura- 
tion. 

On microscopic examination it is found that these blood vessels 
have extremely thin walls, — indeed, it is not rare to find the walls ap- 
parently lacking, either on account of the rupture of the vessel wall, 
or on account of the fact that the cancer cells have invaded and filled 
the original vessel, until its walls have been lost in a mass of the cancer 
cells. Such tumors are indeed extremely dangerous to life, and the 
danger is partly due to the fact that the cells which invade these thin 
walled vessels are so easily carried to other and perhaps distant organs 
of the body, there to begin a new colony of growing cancer cells. These 
colonies, or metastases, are composed of the same type of cell as the 
original growth, and it is sometimes possible to determine within 
fairly accurate limits, the origin of the primary tumor. In the slides 
under the microscopes, there is a specimen of cancer of the liver, in 
which the invading cells present marked resemblance to the cells of 
the mammary gland at an early stage of its development. It might be 
supposed, and in this case the supposition would be well based, that the 
patient suffered from a mammary cancer, and that the cells from the 
mammary gland were carried, either by the blood or by some other 
channel, to the liver. Cancer of the stomach often is the original site 
of a tumor, whose cells may be carried to the liver, or to the brain, 
or indeed to almost any other place in the body. 

The cancer owes much of its malignancy to its rapid growth, and 
to this power which it has, through its own lack of a wall, and to the 
thinness of the walls of the blood vessels, of causing metastatic growths. 
Another cause for its intensely malignant effect is due to the fact that 
the rapid metabolism which these cells undergo causes the formation 
of great amounts of katabolic products, — that is, of wastes of cell 
growth. These must be drained into the blood and lymph channels of 
the body, and finally eliminated from the body, if at all, by the action 
of the kidneys, the lungs, and the other organs of elimination. The 
increased burden thus put upon these organs is sometimes greater than 
they can bear, and the body is poisoned as well as partly starved. 

Tumors which are based upon the type of growth of the embryonic 
glands, — carcinomas, — have yet another method of destruction. They 



328 APPENDIX II. 

are essentially glandular, and they seem to produce substances repre- 
senting a modified secretion. These tumors are not provided with 
ducts, and the products of their activities are thrown directly into the 
blood and lymph of the body. Very serious toxic influences may thus 
be produced upon the entire body, and to these toxins much of cachexia 
associated with carcinomatous growths is due. 

As the cords of the cancer cells push into the neighboring normal 
tissues, they cause inflammatory reactions of varying intensity. The 
ordinary inflammatory phenomena may cause great formation of con- 
nective tissue, and further growth of the tumor may thus be delayed 
to a certain extent. It is in this manner that the capsule of the benign 
tumors is formed, and the process is practically the same as that by 
means of which the capsule is formed in tubercular reactions — the wall 
of the tubercle is formed much in the same manner. In malignant 
growths, however, this scar-like formation may be invaded by the out- 
growing cancer cells, and in this way the scirrhous type of cancer is 
formed. Various combinations of adult connective tissue and embry- 
onic connective tissue, or epithelial or glandular tissues, are thus pro- 
duced. 

One result of the inflammatory process is the formation of "giant 
cells." These are found in abundance around the edges of the more 
malignant cancers, and their origin and their function has long been 
a mystery. They are supposed by some investigators to be evidences 
of great malignancy, and to be themselves harmful. This may be the 
case. But on the other hand they often appear to contain within their 
own bodies cancer cells. It has been supposed that this is due to the 
fact that the cancer cells have invaded and attacked the giant cells. 
But I think that if you will study the slides under the microscopes 
especially you will find that this tissue shows the cancer cells which 
are within the giant cells to present various signs of injury. They do 
not stain well; their protoplasm is vacuolated; their cell outlines are 
irregular and vague ; indeed, they appear as if they were being digested. 
On the other hand, the giant cells which contain the cancer cells do not 
show any particular evidences of disturbed physiological activities. 
It is true that some, — very many, in fact, — of the giant cells are over- 
filled with cancer cells, and that these often appear to be in a dying 
condition. About the same thing can be said of the phagocytes of the 
blood, — they may often be found over-filled and dying, with their 
bodies containing great numbers of bacteria which they have eaten, 
and whose ingestion is probably of so great influence in protecting the 



NEOPLASMS 329 

body from infections. It is also true that the phagocytes are found 
in greatly increased numbers in the neighborhood of infectious agents, 
and especially of such infectious agents as have marked virulence, so 
that in the case of the giant cells we have an appearance which in many 
ways suggests the manner of action of the phagocytes. 

This may not be a correct view, — I certainly should not wish to 
draw any decided conclusions from the study of the few dozen slides 
which I have been able to study with any great degree of care; but 
so far as I can now see, it appears to me to be very probable, to say 
the least, that these giant cells are indeed friends of the body; that 
they are derived from the endothelium of the capillaries and perhaps 
from other cellular elements of the body, and that they protect the 
body, as far as they are able, from the invaders by eating up and 
digesting the cancer cells. 



APPENDIX III. 

*DEATH IN PULMONARY TUBERCULOSIS. 

I am enabled to present the following report through the kind- 
ness of the secretary of the clinic : 

The clinic records of the Pacific College show eleven deaths from 
simple or complicated pulmonary tuberculosis. 

Three of these patients appeared to be in the earlier stages of 
the disease. One patient had been seriously disappointed in certain ex- 
pectations, one suffered unhappy family relations, the family of another 
failed to recognize the severity of the condition; as a result of these 
conditions, the directions in regard to food, rest, fresh air, etc., were 
disobeyed, the treatments were not regularly given, and the improve- 
ment which might be expected did not appear. Death occurred within 
the year in each case. 

Three patients came to this climate for relief. All appeared to be 
in the later stages of the disease, and in each case the prognosis was 
grave. These patients followed all instructions obediently, received 
the treatment outlined regularly, and appeared to be on the road to as 
complete a recovery as the conditions permitted. They returned to their 
homes in more severe climates, became suddenly worse, and died within 
a few weeks of the relapse. 

Five patients appeared to be ready to die when the first examina- 
tion was made. In one case the condition was complicated by a dilated 
stomach, a mitral regurgitation, and a pronounced melancholia. In 
another the bacilli of tuberculosis were found in the blood ; practically 
every organ of the body gave evidence of tubercular involvement. An 
aortic stenosis was present in another case. All died within a few 
weeks of the first examination. In these cases the care given the 
patients relieved the most distressing symptoms, and death was easy 
in each case. 

In these five cases, death appeared to be inevitable at the first ex- 
amination; at least three, and probably all six, of the other patients 
should have been saved to a fairly long and useful life. 



*A. O. A. Jour., May, 1913. 



INDEX 



Page 

Abolishing Flies 44 

Absinthe _ 272 

Acanthia Lectularia 51 

Adaptations 318 

Address to graduating classes..221, 222 

Addiction to drugs.— 270 

Adenin 198 

Aftermath of measles 87 

Age 156 

Air, at night 16 

Air-borne bacteria 35, 148 

Air, cause of disease 162 

Albumin in urine - 212 

Amebic abscess 58, 65 

Amebic dysentery 19, 57, 64 

American School of Archeology 279 

Amoeba 64, 66 

Amoeba dysenteriae 57, 63 

Amniotic fluid, swallowed 193 

Anemia, due to dibothriocephalus 

latus 75 

Ankylostoma duodenalis 79, 28 

Anopheles _ 46, 61 

Anthrax 15 

Anti-zeists 89 

Archeology, school of. 279 

Architecture of schools 150 

Aristotle, life of 291 

Artificial fertilization 275 

Ascaris _ 68 

Associated colleges 243 

Autolysis 113 

Averroes, life of. 293 

Bacteria 227 

in air 148 

nitrogen-fixing 316 

Bacteriology, value of 227 

Bad air 162 

Bats 52 

Bedbugs 51 

Biological balance 318 

Birds, of Utah 216 

Bitter Boot Valley 54 

Bladder, infection of 238 



Page 

Bladder worm 69, 73 

Blood examinations 229 

Blow fly 42 

Bony lesions and disease 138 

Bony lesions in tuberculosis 192 

Bot-fly 43 

Bothriocephalus 68 

Brickmaker's chlorosis 79 

Broad Street Well 110 

Bubonic plague 100, 101, 102, 104 

Bugs 51 

Bureau of health 254 

Burials, expensive 159 

Calf, fetal 193 

Cancer 327 

confused with yeast in stomach 238 

and hydatid mole 187 

Carrel, Alexis, life of 307 

Carriers ....24, 38 

of diphtheria 25 

of gonorrhoea 27 

of meningitis 24 

of tuberculosis 26 

of typhoid 26 

Cast, intestinal 66 

Casts in urine 212 

Cattle bane 59 

Cells, reproduction of 266 

Certified milk 129 

Ceruminous gland, development of 175 

Cesspools 66, 108 

Chick, weight of 206 

Children 145, 149 

Chinch bug _ 51 

Chocolate 198 

Chlorophyll and starch 314 

Cholera 17, 18, 110 

Chorionic villi 186 

Cicada 51 

Cleanliness and isolation 28 

Cockroaches 51 

Coffee - 199 

Cold storage Ill, 115 

Colleges, osteopathic 241 



332 



INDEX 



Page 

Collemia - 200 

Combe, George, life of 299 

Contamination of food 118 

Copper sulphate 273 

Corn, in pellagra 89 

Cost of crime 37, 109 

of living 284 

of sickness _ 109 

Course of study 224 

Cow-itch _ 77 

Crime and degeneracy 210 

cost of 109 

Criminals _ 37, 109 

Crookes, Sir William, life of 309 

Culex 46 

Cures, nature of _ 136 

Curriculum 224 

Cuspidors and tuberculosis 97 

Cyst, dermoid _ 204 

Cysticercus 69 

Cystitis, due to yeasts 238 

Day-dreaming .. 137 

Death, of children 223 

Death, preventable 12 

Decay, cause - 113 

Degenerates 208 

Degrees 250, 253 

Department of Health _ 48 

Dermacentor venustus 55 

Dermoid cyst 204 

Development of epithelium 171 

Dew-itch _ 28, 77 

Diagnosis 229 

laboratory 231, 233, 237, 239 

modern _ 322 

Dibothriocephalus latus 75 

Diphilidium caninum 75 

Diphtheria 25, 39 

Dipterous insects 41, 45 

Dirt and disease 21, 29 

Dirt-eaters .. 78 

Disease, by air 35 

by carriers 24 

by personal contact..— 20, 29, 32 

cost of 12 

from milk 131 

by germs outside the body.... 14, 17 



Page 

Distoma 68 

Doctor as teacher 146, 160 

Dog-itch _ 77 

Dourine 59 

"Drit" 21 

Drugs 21 

experiments with 197 

habit of 270 

older use of 222 

Dust, cause of disease 162 

Dysentery, amebic....l9, 21, 57, 63, 64 

bacillary 21 

tropical 64 

Earlier research work _ 259 

Ectoparasites 68 

Education of osteopath 221, 229 

osteopathic 221, et seq. 

Effects of stimulation on im- 
munity 190, 194 

Eggs 115 

artificial fertilization 275 

incubating 206 

weight of 206, 259 

Egyptian chlorosis _ 79 

Endogenous purins 199, 201 

Endoparasites 68 

Entameba coli _ 118 

Entameba histolytica 64 

Enteric glands, development of 174 

Epistaxis _ 273 

Epithelial organs, development of 171 

Epithelium 171 

germinal _ 180 

Eugenics 37 

Evils of late hours 145 

Exogenous purins 199, 201 

Expensive burials 159 

Experiment with pulse 259 

Fee-splitting 258 

Fertilization, artificial 275 

Fetal calf 193 

Fetal cord, hemorrhage of 203 

Fibroma of uterus 188 

Filth and flies 165 

Fleas 47 

Flies _ 40, 41, 165 

and filth 44, 165 



INDEX 



333 



Page 

Plies and poliomyelitis 36 

blowfly 42 

bot-fly 43 

horse 42 

house 40, 41 

onion 43 

screw-worm 43 

stable 42 

tse-tse 59, 61 

typhoid 41 

warble 43 

Flukes 68, 80 

Fomites 20, 32 

Food, contamination 118 

preservatives 113 

Free dispensary 257 

Funerals, expensive 159 

Galen, life of 289 

Gall-bladder, development of 175 

Gastric glands, development of 174 

Germinal epithelium, development 

of 180 

Germs, outside the body 14, 17 

Giant cells 328 

Glands, development of. 173 

ceruminous 175 

lingual 174 

mammary 177 

poison 174 

sudoriferous 175 

tear 175 

Glossina palpalis 59 

Glycogen 316 

Gonococcus 154 

Gonorrhoea 20, 27, 154 

Graffian follicle, development of... .180 

Ground itch 28, 77 

Guanin 198 

Habits, drug 270 

Hair, development of 178 

Hayden, William J., life of 310 

Health, foundation of 7, 23 

notes 136, 257 

State bureau of 254 

Hemiptera 51 

Hemorrhage, into fetal cord. 203 



Page 

High-heeled shoes 137 

Hippocrates, life of 287 

oath of 288 

Hook worm 28, 76, 79, 169 

Hook worm disease 79 

Horse fly 42 

House flies 40 

Human parasites 67 

Hydatid mole 185 

Hydrophobia 91, 93, 95 

Hymenolepsis nana 75 

Hypoxanthin 198 

Hysterical fears 256 

Ice cream 133 

Ichthyol 268 

Immunization and public hygiene 168 

Independent college, place of 249 

Index, opsonic 190, 312 

phagocytic 194 

Individual responsibility 140 

Industry, useful 141 

Infantile paralysis 86 

fear of 256 

Infection, by meat 110 

by water 110 

Infections 321 

Inheritance, law of 274 

Insanity, inheritance of 274 

Intestinal cast 66 

Irrigation with sewage 106 



Ivy, poison of 83 

Jacobson's organs 178 

Kidney, injury of 267 

Kissing bug 51 

Laboratory diagnosis 231, 233, 237, 239 

Lamblia duodenalis 118 

Late hours 145, 166 

Lateral line organs 177 

Leeuwenhoek, life of 297 

Leguminous plants and nitrogen. ...316 

Length of life ~ 155 

Leukemia 181 

Life, length of 155 

Lingual glands, development of....l74 



334 



INDEX 



Page 

Lister, Lord Joseph, life of 301 

Liver, development of 175 

Liver-fluke 69 

Macrophages 157 

Malaria 18, 45, 49, 61, 237 

Malpighi, life of 295 

Mammary glands, development of 177 

Mastigophora 63 

Measles 36, 87, 88 

Meat as carriers Ill 

Medicines, effects of 266 

harm of _ 266, 269 

Mendel's Law 274 

Meningitis 24 

Messmates 67 

Metchnikoff, life of 303 

theory of old age 156 

Milk 125, 127, 239 

amoebae in 65 

and bacteria 125, 128, 238 

and typhoid 125, 131 

cause of disease 164 

certified 129 

culture for amoebae 65 

definition 127 

examinations ....265 

diseases from 131 

preservation of 130 

Miner's anemia 79 

Modern diagnosis 322 

Molds in bladder 238 

in stomach 238 

Mole, hydatid 185 

Mosquitoes 45, 61 

Mutualists 67 

Nagana 58 

Nasal cavity, development of 178 

National Department of Health 48 

Neeator Americanus 79 

Negri bodies 94 

Nemathelminthes 68 

Nematode worms 76 

Neoplasms 325 

Nerve centers 260 

Neuro epithelium, development of. ...177 

Night air 16, 50 

Nitrogen-fixing bacteria 316 



Page 

Oak, poison of 83 

Oak tree 285 

Oath of Hippocrates 288 

Old age 156 

One-foot skating 99 

Onion fly 43 

Opsonic index 190, 312 

Opsonins 194 

Orthoptera 52 

Osteopathic physicians 281 

Osteopathy 221, 255, 261 

Oxygen and chlorophyll 314 

Oxyurus vermicularis 71 

Oysters and typhoid 134 

Pancreas, development of 176 

Paralysis, fear of 256 

infantile 86 

Parasites 67, 73, 208 

Paraxanthin 198 

Pasteurization 130 

Pellagra 89 

Persecution of osteopaths 248 

Personal hygiene 166 

Phagocytic index 194 

Pharmacopoeia, U. S 264 

Phosphorescence 179 

Phylloxera 51 

Physician and public health 161 

and society 222 

osteopathic 281 

Pituitary body, development of 176 

Plague 100, 101, 102, 104 

Plasmodium malariae 45 

praecox 45 

vivax 45 

Platyhelminthes 68 

Playgrounds 149 

Poison ivy 83 

oak 83 

Poliomyelitis 36 

Preservation of milk 130 

Preservatives of foods 113, 115 

Prevention of ill health 161 

Prostate, development of 176 

Protozoan 57, 93 

diseases 60, 64 

Public health 161 

Purin bodies 198 



INDEX 



335 



Page 

Purins, endogenous 199, 201 

exogenous 199, 201 

Eabies 91, 93, 95 

Eats 100, 101, 104 

Becovery 138 

Eemoval of tonsils 152 

Eeproduction 172 

Besearch work 259, 261 

Eeservoirs 123 

Besponsibility 140 

Bhizopoda 64 

Bhus, diversiloba 83 

toxicodendron 83 

venenata 83 

Bodents and plague 100, 104 

Saliva and disease 29 

Sanitation 11 

San Jose scale 51 

Santa Fe 276 

Sarcodina 63, 64 

Scarlet fever 32, 36, 39 

School architecture 150 

children 145 

Screw worm fly 43 

Sebaceous glands, development of 175 

Selling students 257 

Septic tanks 106 

Sewage - 106, 122 

and irrigation 106 

Sewers 108 

Shoes, high-heeled 137 

Skating 99 

Sleeping sickness 58, 63 

Small pox 35 

Spermatazoa, measurements of 213 

bull 215 

cat _ 214 

dog 214 

man _ 214 

mouse 215 

rabbit 215 

rat, white 215 

Spinal contour in tuberculosis.. 192 

Spirochete pallidum 59, 63 

Spleno-medullary leukemia 181 

Splitting of fees 258 

Sports _ 53 



Page 

Spotted fever tick 54, 63 

Stable fly 42 

Standards, educational 246 

Starch 314 

State and individual _ 140 

bureau of health 254 

medicine 247 

University and medical educa- 
tion 247, 249 

Stomach, infections „ 238 

Students, qualifications of 257 

sale of 257 

Subluxations 138 

Sudoriferous glands, development 

of 175 

Suffrage, of women 283 

Suprarenals, development of 176 

Surgery, needless 322 

Suria _ 58 

Syphilis 59, 63 

Taenia echinococcus 74 

eliptica _ 75 

nana 68 

saginata 68, 74 

solium _ 68, 74 

Tanks, septic 106 

Tapeworms 68, 72 

Tax of crime „ 109 

of sickness 109 

Tea 199 

Tear glands, development of 175 

Teeth, development of 178 

Testis, development of _.180 

Tetanus 14, 34 

Theobromin _ 198 

Theory of old age 156 

Thermometer, development of 262 

Three-year course 241 

Thrush 165 

Thyroid, development of 176 

Tick, of spotted fever 54, 63 

Ticks 47 

Tobacco and children _ 166 

and tuberculosis 97 

and young people 143 

Tonsils, removal of 152 

Training _ 144 

Trematodes 80 



336 



INDEX 



Page 

Treponema 63 

Trichina 68 

Trichomonas intestinalis 118 

Trypanosome gambiense 58, 63 

Tse-tse fly 59, 61, 63 

Tuberculosis ....26, 32, 37, 97, 98, 330 

and milk 164 

bovine - 164 

opsonic index in 190, 312 

phagocytic index in 195 

spinal contour in 192 

Tumors 185, 204, 205, 325 

Tunnel anemia _ 79 

Typhoid and oysters 134, 15 

and milk 16 

and water 163 

fever 15, 18, 23, 26, 96, 111 

fly 41 

Tyranny 283 

Uranalysis 229 

Urethra, glands of 176 

Uric acid 198 

colloidal form 200 

Useless and useful industry 141 

Utah, birds of. 216 

Uterus, abnormalities of 188 

adenoma of 189 

cancer of 189 

fibroma of 188 

structure of 188 

Vacant lots, use of 284 



Page 

Van Leeuwenhoek, life of 297 

Ventilation .. 147 

Vermes 72 

Viceral reflexes 259 

Vomero-nasal organs 178 

Wallace, Alfred Eussel, life of 306 

Warble fly 43 

Warm-blooded animals, develop- 
ment of 319 

Water and typhoid 163 

as carrier of disease... .110, 120, 163 

cold 124 

contaminated 121 

good 123 

infected 120 

polluted 120 

test of 121, 163 

Weber, rules of health 158 

Weight of egg and chick 206 

Wine 141 

Woman's suffrage 283 

Worms, nematode 76 

parasitic 67 

Xanthin 198 

Yeasts, in bladder 238 

in stomach „ 238 

mistaken for cancer 238 

Yellow fever 17, 32 

Young people and tobacco 143 

Zeists 89 



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